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OUIDE TO SOUND TEETH, 



OS 



A POPULAR TREATISE 



m THE TEETH, 



51XUSTRATING THE WHOLE JUDICIOUS MANAGEMENT OF THESE ORGANS 
FROM INFANCY TO OLD AGE; IN WHICH THE AUTHOR WILL AT- 
TEMPT TO SHOW, THAT THE TEETH OF ALL PERSONS WHICH 
ARE CONSTITUTIONALLY WELL FORMED. AND WHO ENJOY 
GOOD HEALTH, MAY, BY PROPER MANAGEMENT AND 
CARE, BE PRESERVED TO THE END OF LIFE. 



BY SHEARJASHUB SPOONER, M. D. 



Si opinio, de conservation dentium, quam omnes homines, chirurgica scientist 
Pentium instructi, hoc tompore, tenent, [nempe, ut dentes, per totam vitam pre- 
servati sint,] justa sit, ad usum generis humani, earn opinionem promulgari 
«$ertet.— Vide Dissertationem Inauguralern Auetoris^ jpagina ix. Exordii. 

If it be true, that the teeth may be preserved t o the end of life, as scientific 
surgeon dentists of the present day believe, the means by which this desirable 
©feject can be attained, should be promulgated for the benefit of mankind. 



NEW-YORK : 
WILEY & LONG, 161 BROADWAY. 

1836. 







Entered according to the Act of Congress, in the year 1836, by 
S.1SPOONER, M. D. 
in the Clerk's office of the District Court of the United States, for the 



Southern District of New York. 



J2 f 67 



J. AND W. SANDFQRD, PRINTERS, 29 ANN-ST. 



CONTENTS 



Page. 

INTRODUCTION - 3 

Reasons for publication * 4 

List of authorities 12 

NATURAL HISTORY OF THE TEETH - - 15 

Anatomy and physiology of the teeth - * •- 15 

Composition of the teeth ----- 16 
Nerves of the teeth - - . - - - -17 

Situation of the teeth in different animals— Note § 16 

Description of the* teeth - - ~ - 19 

Formation of the teeth - - - - - 21 

Formation of the temporary teeth - - - 21 

Table of the periods between which the temporary teeth are cut 24 

Sports ©f nature — Note --».-- 23 
Formation of the permanent teeth - - - -25 
Physiological observations on the food of man, deduced from 

the characters of his teeth - 28 

TEETHING - - - - - - 31 

Effects of teething on the system - 32 

Mortality caused by the irritation of teething - 32 

Treatment of difficult dentition - 33 

Dr. Good's observations - - - - 33 

John Hunter's observations; lancing the gums 35 

Infantile diseases caused by the irritation of teething - 36 

Coral or ivory put into the hands of children - 30 



SHEDDING OF THE TEMPORARY TEfiTH AND THfe 

SECOND DENTITION - - - - 37 

Shedding of the teeth a curious operation of nature - 37 

Time at which shedding the teeth commences - 38 
Table of the medium periods at which the permanent teeth 

are cut - 38 

IRREGULARITIES OF THE TEETH - - - 39 

Irregularities of the teeth of frequent occurrence - 39 

No occasion for irregularities of the teeth - * 39 

Duty of parents to attend to the second dentition - 40 

Causes of irregularities of the teeth - - - 40 

Treatment of irregularities of the teeth - 44 
Injurious effects of the premature removal of the temporary 

teeth - - - ; - - - 41 
Impropriety of extracting the temporary molar teeth for tooth 

ache — Note ------ 42 

INAUGURAL DISSERTATION = - - - 48 

Reasons for publishing the Inaugural Essay 48 

Structure of the teeth - - - - - 49 

Vascularity of the teeth— importance of establishing this point 50 

Hunter's and Bell's opinions - - - ? 5Q 

Hunter's reasons for doubting the vascularity of the teeth - 52 

Vascularity of the teeth established - • - 61 

DISEASES OF THE TEETH. - - s - 6 I 

Caries of the teeth - * - = 63 

Opinions of authors as to the causes of caries - 64 

The subject discussed .... - 72 

True causes of caries - ? - * 8§ 

Internal caries ? * - - 83 
External caries -------87 

Odontitis ------- 93 

Periostitis -------94 

Exostosis • 94 

Necrosis - - - '• - 94 

Denuding process of Hunter - 94 

Abrasion - * - • • - 95 

Transplanting the teeth— iVbfe ... - 78 

Excision of the teeth — Note - - - - 79 

Effects of sugar on the teeth — Note - • 85 

Effects of tobacco on the teeth— -iVote - • - 86 



CONTENTS. V 

Acids in the saliva —Note .... 89 

Effects of mercury on the teeth - • - 87 

Effects of mineral acids on the teeth 91 

Effects of vegetable acids on the teeth • - - 91 

Affinity or chemical attraction - - - • 91 

PREVENTIVE TREATMENT OF CARIES - - 97 

Effects of a crowded state of the teeth - - 92 

Extraction of the four posterior bicuspid teeth - - 99 

Extraction of the four anterior molares - 101 

CURATIVE TREATMENT OP CARIES - - 104 

Plugging the teeth » - * • 104 

Utility of plugging the telth '- - - - 105 
Manner of plugging the teeth that success may attend the 

operation - . - ... 109 

Reasons why the operation so often fails • - 101 

Quacks— Note - - - - - - lOt 

Importance of employing a scientific dentist - • 107 

Pain of dental operations - - - - - 113 

Importance of having dental operations for the cure of caries 

early performed - - - - - 112 
A fit state of the mouth for the performance of operations on 

the teeth for the cure of caries - - * - 114 

Treatment of the teeth when caries ha3 progressed to the 

nerve ------ i llg 

Application of arsenic - - - -- -115 

Materials proper for plugging the teeth • • - 119 
Cements— of little use ..... 121 

Empiricism— the Crawcours* -Note - 122 

Filing the teeth - - - - - 123 

Rules for filing the teeth - i - - - 129 

Utility of the judicious use of the file - - - 131 

Injurious effects of the injudicious use of the file - 129 

SCURVY IN THE GUMS =• * - • - 137 

Species 6f the disease » 137 

Symptoms - - - • • - 139 
Causes - - « - * - ■ 139 

Method of cure .... i - 140 

Disease easily cured • * - 141 

TARTAR OF THE TEETH - - • - 149 

Effects of tartar - - - - - * 151 



VI CONTENTS. N 

Means of keeping the teeth free of tartar - - - 152 

Scaling the teeth - - . - - - - 153 

Polishing the teeth - - - - - - 154 

Method of polishing - . - - - * 155 

DEAD TEETH AND ROOTS - * * - 156 

Effects of dead teeth and roots - 157 

GUM-BILES - - - - - - - 157 

Cause of gum-biles - - - - 158 

Treatment - - - - . 158 

Effects of gum-biles when neglected » - - 159 

FETID BREATH • - - - - - - 160 

CLEANLINESS OP THE MOUTH 161 

IMPORTANCE OF CLEANLINESS OF THE MOUTH 162 

Means of keeping the mouth clean - 163 

Tooth brushes - - - - - - - 163 

Manner of using the brush - 

TOOTH PICKS - 168 

TOOTH POWDERS - - - - 168 

TOOTH ACHE - - - - - , - 173 

Remedies for the tooth ache - 174 

IMPORTANCE OF THE TEETH TO THE ANIMAL 

ECONOMY 178 

Loss of the teeth injurious to the general system - 178 

Teeth essential to articulation - - - - 179 

Teeth essential to beauty. - - * - - 180 

Loss of the teeth produces deformity - 179 

EFFECTS OF DISEASED TEETH GUMS AND SOCK- 

ETS UPON THE CONSTITUTION - - 181 

Local affections caused by these diseases - 181 

Tic-douloureux - - - - - - 182 

Malignant diseases of the jaw-bones - 182 

IMPORTANCE OF THE PRESERVATION OF THE 

BACK TEETH - j - - - 1W 



CONTENTS. Vll 

OPERATIONS ON THE TEETH OF PREGNANT WO- 

MEN » 184 

MANAGEMENT OP THE TEETH FROM INFANCY 

TO OLD AGE. - - - - - - 187 

ARTIFICIAL TEETH - : - - § , 201 

Utility of artificial teeth —Note - - - - 201 

Substances of which artificial teeth are made - - 202 

Pivotting teeth on stumps— Note - . - . 202 

Mineral teeth ------ 203 

GLOSSARY - , - - ". - - - 206 



INTRODUCTION. 



Being about to present to the public, as our title page 
imports, a popular essay on the diseases and management 
of the teeth ; it may not be altogether inappropriate, in- 
asmuch as the work is not designed exclusively for the 
use of the dental profession, but for general utility, to render 
some of the principal reasons which have influenced us in 
undertaking, and guided us in the prosecution of it. 

And first, the great propensity to disease, to which, in 
this our country, the teeth are unfortunately liable ; and 
the consequent urgent necessity of some fixed and definite 
rules to guide the citizen to the means by which he 
may obviate the same, when it may be obviated, and 
when it may not be, to point out, next the appropriate and 
only safe means by which it may be effectually remedied ; 
at least, so far as the individual case will admit of remedy. 

Second, the existing necessity of such a work ; there 
being none upon our subject, extant^ that is at all applicable 
to popular use. 

Third, a laudable desire to "contribute our voluntary, 
though feeble aid, for the object of exalting the abused pro- 
fession, of which we are a member, to that respectability 
which the imperious necessity of its existence in our country, 



IV. iNTEODXJCTiON, 

and the utility of its correct and faithful practice eminently 
entitle it to ; and to shield it from that opprobrium which is 
too often cast upon it, not because it is intrinsically worth- 
less, but because it is frequently rendered useless, nay, 
injurious by the host of those itinerant (I beg pardon, itine- 
rant or resident) vagrants, who assume, for the sake of lucre, 
to manage the functions and discharge the duties of a pro- 
fession, their ignorance of which, to say the least, is ex- 
ceeded only by their impudence and rapacity, or their 
sordid love of unearned gain. 

And another reason ; if we be so fortunate as to treat 
our subject judiciously, to represent its merits faithfully, 
and to elucidate it clearly, in order that it may be more 
generally understood ; to accomplish though partially, our 
design, as before expressed, that we may possibly derive an 
advantage tantamount to our trouble in executing the un- 
dertaking* 

Thus, it will be seen that we have a tripple object ; viz. 
to benefit community, our profession and ourselves. 

But as to the latter, we are not so idly vain, as to expect j 
or hope that our exertions will be crowned with golden 
rewards, with literary fame, or with professional distinction ; 
but rather, in aiding our profession to subserve the interests 
of community ; to have that profession respectable, as it 
shall be useful ; and to render oui selves useful in the sphere 
of our profession ; aiming to participate in the general 
advantage. 

Our design is to present a familiar treatise on the subject 
of the teeth ; pointing out the most judicious management 
of these organs from infancy to old age. Such as the 
requisite care to be bestowed on them, by those who have 
the management of children ; and subsequently, that, by 
the individual possessor himself; and that again, which it 



INTRODUCTION. V. 

fe the province of the dentist to afford, when called for, 
which method of treatment, will be founded on such princi- 
ples and practice, as is now sanctioned by all scientific and 
well instructed dentists. We shall endeavor to discriminate, 
and to make the point appear obvious to all interested, be- 
tween care of, and neglect of the teeth ; between judicious 
and injudicious treatment of them, by the individual posses- 
sor ; between the advantage of a knowledge of their forma- 
tion, structure, individual characters and diseases ; and the 
disadvantages of an ignorance of them, in those, who 
attempt to treat them surgically ; in fine, between the 
application of judicious and approved means, for the pre- 
vention and cure of their diseases ; and the application of 
injudicious and incorrect ones — such a work, if successfully 
executed, is believed to be a dissideratum ; and as such, 
cannot fail to be of great and general utility to commu- 
nity. 

It is the opinion of scientific dentists of the present day, 
that the teeth of most persons may, by proper manage- 
ment, be preserved to the end of their lives. That this 
opinion is correct in t'ie main, we unequivocally profess to 
believe ; and shall use our best endeavors to prove ; point- 
ing out with as much precision as possible, the appropriate 
means to be employed, by which so desirable an object may 
be attained. 

If the opinion be correct, it must appear obvious to any 
person who will reflect on the importance of the teeth as 
organs of mastication and of articulation ; their influence 
upon our personal appearance and comfort ; their extreme 
liability to disease, in our country ; and on the injurious 
effects of that disease, operating upon the general system, 
through the pain and its- consequent irritation induced, that 
the appropriate means for attaining so desirable and so 



VI. INTRODUCTION* 

necessary an object, ought to be promulgated for the benefit 
of all. 

The views of most persons with respect to the proper 
management of the teeth, unfortunately for themselves, are 
extremely erroneous, and for obvious reasons ; viz. want of 
correct information relative to the full subject. And these 
views must needs be corrected, and this deficiency supplied, 
before the necessity of the practice of dental surgery, and 
its utility, as practiced on principles of science and integrity, 
(for such practice only we shall attempt to defend,) can 
-become generally known and appreciated. 

However useful may be the profession of dental surgery ; 
however true may be the doctrine, that the teeth may be 
preserved to the end of the life of the individual ; all will 
be of no avail to the citizen, unless he be seasonably ap- 
prised of the fact, in order that the means may be applied 
before they become inefficient by too long a delay in their 
application. For instance, many of the diseases of the 
teeth are best met by a preventive treatment ; and such 
treatment should commence with earliest dentition, 
and should be directed subsequently according to the ex- 
istence, progress and proneness to disease of each individual 
case. Children's teeth should be carefully inspected from 
time to time, and every obstacle to regularity promptly 
removed ; early and habitual attention should be paid to 
cleanliness, and this accomplished too, by such agents as 
will have no injurious effects upon the teeth themselves, 
their sockets, the gums, or upon the healthy secretions of the 
mouth ; to remove or rather prevent all incipient causes of 
caries, or of any other disease to which they or their ap- 
pendages are liable. And no one, surely, can need argu- 
ment to convince him, though he may need the suggestion to 
remind him, that it is infinitely better, on the score of utility, 



INTRODUCTION. vfi, 

comfort and economy, to preserve the natural teeth, than 
to neglect and lose them, and afterwards require, as sub- 
stitutes, artificial ones. Hence we found the presumption, 
that a work like the one which we propose, upon this sub- 
ject, will be of general utility. 

The perusal of medical works by persons out of the pro* 
fession, may probably be of no advantage to them ; but the 
perusal of a judicious work upon the diseases and the best 
management of the teeth, especially in the present state of 
conflicting opinions on the subject, we think, will prove of 
essential service. And first, because, as has been be- 
fore remarked, persons generally are unacquainted with 
the most proper means to be employed for the best security 
of the teeth : second, because such is the structure, nature, 
exposure and liability to decay of these organs, that every, 
thing relative to their preservation depends upon daily care, 
or a constant application of such of the means of preserva- 
tion, as are naturally and necessarily within the province of 
the individual himself; and another circumstance; the situation 
of the teeth is such, and they often decay in such parts, tbat 
they are not unfrequently screened from the eye of the pos- 
sessor, and even from that of an inexperienced operator, and 
defy his detection ; and their structure is such, that the 
possessor is not sufficiently admonished of their very de- 
fective state, by their appeal to his sensibilities,, until that 
state is become almost entirely hopeless, and consequently 
operations for the preservation of them useless. Resorting 
to remedies for them in this state, is like a sick man in the 
last stage of some organic disease applying to the physician 
for relief, who, notwithstanding he may have an accurate 
knowledge of the character, symptoms, progress and tenden- 
cy of the disease ; and with the very best means for combat- 
ing it ; yet, he can only palliate now, that, which in its inci^ 



Vlli, INTRODUCTION. 

pient state he might have cured. From this improvident 
care of the teeth, and from this injudicious management, 
this procrastinating process" which invariably leads to evil, 
have arisen, we think, in a great measure the exagerated 
ideas relative to the pain of dental operations ; and after all 
the solicitude and forebodings, and pain submitted to, and 
expense incurred 1 ,— the inutility of tht? process. But though 
much that is complained of, as the evils of dentistry, may 
be attributed to this childish, this improvident, this temporis- 
ing mode of management of the teeth, dictated not by the 
best judgement of the individual, but rather forced upon him 
by his ill-founded fears, aided perhaps by his distrust of the 
efficacy of the treatment ; yet more, much more to the host 
of squatters m o-u* profession, who, like sin, * are a reproach 
io any people," who disgrace and abuse, nay, murder the 
profession ; who first flatter their patient, then wheedle* 
then torture, then fleece 3 and then,— what 1 why? 

v To ease themselves of divers slanderous loads^ 

they turn him 6ff f 
Like to the empty ass, to shake his ears, 
And graze in commons," 

Many persons have embraced the erroneous opinion that 
dental sugery is merely a mechanical art, and that its prac- 
tice does not require much professional science or knowl- 
edge of the anima! economy. But this is truly ae error; 
and like all error, tends to delude, and exposes to imposi- 
tion. It may properly be divided into two branches ; viz. 
surgical and mechanical dentistry. To the latter be- 
longs the substitution of artificial teeth upon plates, &o. ; 
and to the former, the preservation of the natural ones, and 
all operations upon them that require an interference with 
the living fibre ; which in effect, are truly and exclusively 
gyrgical, inasmuch as we are operating upon living parts ; 



INTRODUCTION. \X, 

and parts too, intimately connected with the living human 
system by virtue of that life, and of their functions. 

Thus, we trust, that it will be made to appear evident 
in the sequel, that to practice dental surgery with success, 
a man must possess a knowledge of the animal economy, of 
its functions, of its diseases which influence the parts upon 
which he operates, and of the effects of the diseases of these 
parts upon the general system, operating through sympathy, 
or through painful irritation upon it : and a knowledge of 
the surgical and curative means sufficient to avoid all 
harsh and unnecessary infliction of pain, all unnecessary 
aggravation of irritation of diseased parts, and to be able to 
apply the most approved remedies for the mitigation of pain, 
and for the arrest of disease. 

That there should be entertained by community, a con- 
trariety of views relative to the requisite care of the teeth ; 
to their diseases and to the query of who may, and who 
may not, with safety, be permitted to treat them, is not at all 
surprising, in the present state of the dental profession ; 
and more especially, when we reflect that the art of expel- 
ling caires from the mouth, and effectually preserving teeth 
that have suffered even considerable from its ravages, by 
operation, is, to many, a new thing ; that generally, public 
attention has been directed more to artificial teeth, than to 
the preservation of the natural ones ; and that so far as 
operations have been submitted to, a great majority of them 
have been performed by persons too little versed either in 
the principles or practice of the profession, to ensure suc- 
cess ; and that the discrepencies of opinions, views, modes 
of practice and representations relative to the t^eth, held 
out to patients, by such a discordant, untaught,, assuming 
set of practitioners, should increase the embarrassment, and 



X. INTRODUCTION. 

totally exclude the possibility of acquring the public confi- 
dence for the profession, is as little matter of astonishment. 

Yet notwithstanding all this, it is our candid conviction 
that near one half of the diseases of the teeth may be pre- 
vented by early care and proper management ; and the 
greater share of those that are attacked by disease, may be 
effectually and permanently remedied by judicious and faith- 
ful operations : and quite certain it is, that the diseases of 
the gums and sockets, by which so many soiXnd, well ar- 
ranged and beautiful teeth are lost, may be prevented, 
when they do not arise from constitutional derangement, 
which is seldom the case. 

But, in order to secure the above favorable results to com- 
munity, it is imperiously necessary that the " augean stable" 
of this profession should be " cleaned ;" the profession should 
be as much protected and fostered, as those of medicine 
and surgery. Every man, before being permitted to prac- 
tice it, should serve a requisite term of pupilage, and pass 
an examination before a competent board of surgeon 
dentists. 

One thing is certain, this profession must either rise or 
sink. If means are not taken to suppress and discounte- 
nance the mal-practices of the multitude of incompetent per- 
sons, who are pressing into it, merely for the sake of its 
emoluments, it must sink ; — for the few conpetent and well 
educated men, who are now upholding it, will abandon a 
disreputable profession, in a country of enterprise like ours, 
and turn their attention to some other calling more conge- 
nial to the feelings of honorable and enlightened men. 

We are happy however, in believing that a great change 
for the better will, in a few years, take place : for experience 
is the best tutor, though often a hard one, for it generally 
brings with it, a corrective. 



INTRODUCTION XI* 

There are many men of science and eminence engaged 
in this profession, in our country, and others are entering it 
with ardor, and though they may not have the effect to 
" leaven the whole lump," yet they will sustain a redeeming 
principle, inasmuch as they will triumphantly exhibit the 
effects of good and sound practice, in contradistinction to 
that which is worthless ; while the good sense of com- 
munity will affix the seal of merited approbation. 

In conclusion, with the most conscientious integrity of 
purpose, we most respectfully present our little work to the 
notice of a generous public, and leave it to its candor and 
liberality to decide on its merits. 

Should our humble efforts prove to be of any adequate 
utility, we will hereafter foster our little volume, by crop- 
ping it of redundancies and by adding such farther facts as 
experience and research may develope, in the hope that it 
may become the standard guide to sound teeth. 

In treating our subject we shall be as brief as is consis- 
tent with our object ; and if we sometimes prove tedious we 
beg the indulgence of the reader. In order to take off the 
tedium of a dull subject, occasionally, interesting matter re- 
lative to the subject will be introduced in the form of notes. 

As we wish no one to take our ipse dixit for gospel, we 
shall use our best endeavors to establish all that we advance 
on incontestible ground, by argument, fact and quotation. 
And as all our readers may not be acquainted with the 
respectability of our authorities, to give them their legiti- 
mate influence, we give a list of their names and standing 
in their professions. 

The work is so arranged that the reader may find the 
information that he may desire under its appropriate head. 



am. INTRODUCTION. 



LIST OF AUTHORITIES. 

John Hunter— The greatest Physiologist, Pathologist, and 
Surgeon of his age. He wrote a work upon the natural 
history and diseases of the teeth, comprising 246 quarto 
pages, illustrated with many engravings. 

Thomas Sydenham, born 1624, died 1689. He is uni- 
versally admitted to have been the greatest physician of 
his age. 

Sir Astley Cooper — The greatest English Surgeon of the 
present day. 

Sir Charles Bell — A very distinguished Scottish Anato- 
mist, Surgeon and Physiologist. 

Mr. Lawrence-— An eminent Surgeon, residing in 
London. 

M. deBlainville — A learned and popular French Zool- 
ogist. 

M. Richerand— A distinguished Physiologist, and Profes- 
sor of the Faculty of Medicine of Paris. 

John Mason Good, M. D., F. R. S. ? F. L. S. &c— A 
very learned physician and celebrated medical writer. 

J. A. Paris, M. D., F. R. S., F. L. S., Fellow of the 
Royal College of Physicians of London, &c. &c. 

Robert Hooper, M. D., F. L. S., Member of the Royal 
College of Physicians of London, <kc. 

Dr. Rush, the great American physician. 



INTRODUCTION* XUl« 



DENTAL WRITERS, 



Robert Blake, M. D., Author of a celebrated work on 
" the teeth in man and various animals ;" published at 
Edinburgh, 1799, 

Joseph Fox, Member of the Royal College of Surgeons, 
London ; and of the Society of Medicine, Paris ; Lecturer 
on the structure and diseases of the teeth at Guy's Hospital* 
and Surgeon Dentist Extraordinary to their Royal High- 
nesses, the Dukes of Kent and Sussex. Mr. Fox wrote a 
quarto work of 180 pages, illustrated with twenty-three 
copper-plates, on the natural history and diseases of the 
teeth. He died a few years ago. 

Thomas Bell, F. R. S., F. L. S., Member of the Royal 
College of Surgeons, London ; Lecturer on the anatomy 
and diseases of the teeth at Guy's Hospital ; Author of an 
excellent work of 330 pages octavo, on the anatomy, phy- 
siology and diseases of the teeth. 

James Snell, Member of the Royal College of Surgeons, 
London ; Author of " A practical guide to operations on 
the teeth, &c." 207 pages, octavo. 

Leonard Koecker, Doctor in Medicine and Surgery, a 
German by birth, and now residing in London. Author of 
Principles and practice of dental surgery, a work contain- 
ing very many valuable practical observations. Mr. 
Koecker has travelled much in Europe and America, lived 
several years at Philadelphia, and has had a good op- 
portunity of observing the practice of dentists in different 
countries. He is one of the most thorough and effectual 
dental operators of the present day. We shall have fre- 
quent occasion to cite his opinions. 

Samuel S. Fitch, M. D., of Philadelphia ; Author of a 



XiV. INTRODUCTION. 

" System of dental surgery in three parts," 558 pages, 
octavo. 

Mr. L.S. Parmly of London, and Mr. E. Parmly of 
this city, men, whose reputation in their profession requires 
no comment from us. 

In fine, we shall have occasion to make brief extracts, 
from the practical observations of many English and 
French dentists of repute, whose names, it is not necessary 
to mention in this place* 



GUIDE TO SOUND TEETH. 



NATURAL HISTORY OF THE TEETH. 

It is not our intention to enter into the subject of the natural 
history of the teeth, farther than we deem barely necessary, in 
order that the reader may fully understand what we shall 
have to say on the management of the teeth, for the preven- 
tion and treatment of the diseases of these organs. 

ANATOMY* AND PHYSIOLOGY OF THE TEETH. 

" The teeth,*' says Mr. Thomas Bell, " may be defined in 
the human subject, as distinct organs of a bony structure, 
attached to the maxillary bones, and formed for the purpose of 
dividing and comminuting the food, preparatory to digestion." 

The teeth are the hardest bones of the human system, as is 
proved by the fact, that in ancient places of sepulture, the 



* Anatomy, (from the Greek, to cut through or up.) "The dissection 
or dividing of organized substances, to expose the structure, situation 
and uses of parts," 

Physiology, (a discourse on nature.) " That science which has for its 
object, the knowledge of the phenomena, proper to living bodies." 

Hooper's Medical Dictionary. 



16 Natural History of the Teeth. 

teeth have often been found in a very perfect state of preserva- 
tion, while all the other bones have crumbled into dust. A 
tooth is composed of two substances ; the bony part, and the 
enamel ; the former is organized and possessed of vitality, 
vascularity and sensibility ; the latter is crystalline. 

The following is the analysis of the human teeth, bylhe 
Swedish chemist Berzelius, and is more elaborate than that of 
any other chemist. 

The enamel of the adult teeth contains in 100 parts : — 

Phosphate of lime ----- 85.3 

Fluate of lime ------ 3.2 

Carbonate of lime ----- 8. 

Phosphate of magnesia - - - - 1.5 

Soda and muriate of soda - - - 1. 

Animal matter and water - - - I. 

100. 

The bone of the adult teeth according to the same celebrated 
chemist, contains in 100 parts : — 

Phosphate of lime - - - - - 62. 

Fluate of lime ------ 2. 

Carbonate of lime ----- 5.5 

Phosphate of magnesia - - - - j ; 

Soda murate of soda - - - - 1.5 

Gelatine and water ----- 28. 

100. 

A tooth is anatomically divided into the crown, neck and 
Fang. The crown is covered by the enamel, which is very 
thick on their cutting and grinding surfaces, and gradually 
grows thinner towards the neck, where it almost insensibly 
terminates. The teeth are articulated with the jaw-bone* iri 



* "It is curious to observe how differently the teeth are situated in 
different animals. In the more perfect^ they are placed in sockets in the 
jaw-bones, some of which are in many kinds rendered moveable, as the 



Anatomy and Physiology of the Teeth* 17 

a manner peculiar to themselves, which anatomist term gom- 
phosis, (to drive a nail) like a nail in a piece of wood. 

Every tooth has an internal cavity somewhat of the shape of 
the tooth itself, which, gradually diminishes in size towards the 
end of the fang or fangs, and terminates in a minute foramen or 
hole. This cavity is rilled with a pulpy substance, commonly 
called the nerve, which is highly vascular and exquisitely sensi- 
tive : the nerve and blood-vessels which supply this substance, 
enter the foramen at the extremity of the root : the roots are sur- 
rounded by a periosteum or membrane which secures the teeth 
in their articulation, and nourishes them by means of the 
numerous blood-vessels penetrating the fangs : the arteries 
which supply both jaws and give off minute branches to the 
teeth, are derived from the internal maxillary branch of the 
external carotid. 

The nerves of the teeth are derived from the fifth fair, 
which is distributed to the face and head, and is the grand 
medium of sensation to these parts. This nerve, according to 



two fore teeth of the lower jaw of the mus maritimus, or African rat, 
the largest species of the genus hitherto discovered. The same teeth 
are equally moveable in the kangaroo; and the hollow tusks or poison- 
ing fangs of the rattlesnake, and other venomous serpents, sire capable 
of depression or elevation at the option of the animal. In the lamprey 
and myxine, the teeth, which are almost innumerable, are placed on the 
surface o f the tongue ; in the cancer genus, in the- stomach ; where we 
likewise find them in the common earwig. In the cuttle-fish, they are 
also placed in the middle or lower part of the body^wo in number, and 
horny, and in their figure resemble the bill of a parrot. In the echinus, 
or sea-hedgehog, they are five in number, arranged around the opening 
of the under part of the shell, and being moveable by different mus- 
cles, they form a very complete or^an of mastication. In the aphrodita 
aculeata, or sea-mouse, they are fixed upon the proboscis, four in number, 
and are consequently extended or retracted with this organ at pleasure. 
The leech has three pointed cartilaginous teeth, which it is able to em- 
ploy in the same way, and by means of which it draws blood freely. 

The form of the teeth is so different, even in the different genera of 
animals that possess them in a true or perfect state, that this diversity has 
been laid hold of by many naturalists, as a distinguishing characteristic 
of their kinds or orders. Linnasus. confining himself to the fore-teeth, 
has hereby formed seven distinct orders for the class of mammalia ; 
and M. cle Blainviile, carrying the basis of this distinction farther than 
to the form and structure of the fore-teeth, has made it a foundation for 
the subdivisions of these orders into genera. 

1* 



18 Natural History of the Teeth, 

Sir Charles Bell, whose theory of the different classes of 
nerves, and the distinct office to which each is assigned, have 
ranked him among the first physiologists of the age, is com- 
posed of two portions, a sensitive, and a motor portion. The 
sensitive portion leaves a small ganglion called the semilunar, 
in three great branches ; viz. the ophthalmic, the superior max- 
Wary, and the inferior maxillary. 

The ophthalmic branch is distributed to the eyelids and parts 
contiguous, to the nose and integuments of the forehead and 
communicates by inosculating branches, with the superior 
maxillary nerve, and with a portion of the seventh pair or au- 
ditory nerve. 

The superior maxillary nerve possesses a more intimate con- 
nexion with our subject, as its branches supply the whole of 
the teeth of the upper jaw. It is divided into various branches, 
the names of which, it is not necessary to mention. These 
branches are distributed to the orbit, temples, nose, cheek, 
mouth and palate. The vidian nerve, one of its branches, is of 
considerable importance, as it is connected with the great 
sympathetic nerve, by means of its deep seated branch. This 
x ntimate connexion with the great medium of sympathy be- 
tween all the vital organs of the body, cannot but be consider- 
ed as highly important in accounting for the various sympa- 
thies existing between the teeth and other parts, and must not 
be lost, sight of, ^hen we enter upon the effects of the irritation 
of diseased teeth, gums, and sockets, upon the general system, 
and the fatal effects of teething, in a future part of this work. 

The inferior maxillary nerve, after giving off some small 
branches to the neighboring parts, divides into two important, 
nerves, the gustatory or the nerve of the sense of taste, and 
the inferior maxillary, which passes in a canal through the 
lower jaw distributing filaments to the teeth. The gustatory 
nerve has a connexion with a part of the seventh pair, or audi- 
tory nerve, by means of a communicating branch, and from 
this connexion, the sympathetic pain in the ear arising from 
decayed teeth, especially if the wisdom teeth of the lower jaw 



< Anatomy and Physiology of the Teeth. 19 

be the seat of the disease, is explained ; hence also the filing 
of a saw or any grating noise sets the teeth on edge. The sym- 
pathetic pains in the eyes, temples and different part of the 
face, caused by diseased teeth, are also explained by the in- 
timate connexion existing between the three great branches 
of the fifth pair. 

Nature has given man (and most mammalia,) two sets of 
teeth; the first, temporary or milk teeth, which are intended to 
serve during childhood, and the permanent or adult teeth, inten- 
ded to last from the falling of the temporary ones to the end of 
life. The reasons of this bountiful provision of nature are obvi- 
ous, namely, the different size and shape of the jaws, at different 
ages, and the peculiar formation of the teeth not permitting an 
increase of growth in them, as in other bones. There are 
thirty-two adult teeth; sixteen in each jaw; namely, four 
incisores, or front teeth, (from the latin incidere, to cut;) two 
cuspidati or eye teeth, (cuspis, a spear, spear pointed,) four 
bicuspides, or small double teeth, (from bis, twice and cuspis, 
two pointed ;) six molares or grinders, (molaris, a mill-stone.) 
The last molar teeth in each jaw are called wisdom teeth, 
(dentes sapiential,) because we generally get them about eigh- 
teen or twenty years of age, or the age of full maturity. 

There are twenty temporary leeih, ten in each jaw ; four 
incisores, two cuspidati, and four molares. 

It is unnecessary to give a particular description of each 
tooth, as every one knows more or less of the shape of the 
teeth from observation. 

The incisores are somewhat wedge shaped, widest at the 
cutting edge and gradually diminishing towards the neck ; 
they are slightly concave externally and convex internally, 
but the concavity is interrupted by a tubercle near the neck. 
They are situated in the anterior part of the jaws, and form 
the centre of the maxillary arch ; each has but otie fang. The 
central incisores of the upper jaw are much larger than the 
lateral incisores adjoining them. The incisores of the lower 
jaw are much smaller than those of the upper, aud nearly re- 
semble each other in shape. 



2G Natural History of the Teeth.* 

The cuspidati stand next to the incisores, and are shaped 
somewhat like them, though more round, much thicker and 
the corners cut off': they are the longest and strongest teeth in 
the head : the cuspidati of the upper jaw are much larger than 
those of the lower, and differently shaped. ^ The use of the 
cuspidati^ 1 says Mr. Hunter, "would seem to be to lay hold 
of substances, perhaps even living animals. " This opinion is 
probably incorrect, as applied to the teeth of man, for his en- 
dowment of reason, and his hands make such a mode of ob- 
taining food unnecessary, while his erect posture,* makes it 
impracticable. Their office is probably to tear the food too 
hard for the incisores to cut. ^ 

The hicuspides stand back of the cuspidati, and between 
these teeth and the molares-, they were formerly called small 
.double jieejih, but Mr. Hunter more properly named them hi- 
cuspides, from the two projecting points. 

The external point is longer than the internal, which makes 
ihese teeth appear very like the cuspidati when view r ed later- 
ally : the anterior hicuspides are a lkstle smaller than the 
posterior : those of the upper jaw h f a.ve two fangs; the lower 
bat one. 

The molares are placed behind the bicusipides, and their 
shape is very similar in both jaws ; the two anterior are much 
larger vhan the posterior or wisdom teeth; those of the upper 
jaw have three fangs, sometimes four, rarely five; one is plac- 
ed! internally and two externally ; the wisdom teeth have two 
fangs ; the two anterior molares of the lower jaw have two fangs, 
;the one placed anterior and the other posterior ; the wisdom 
Xeeth have but one. 

There is a regular gradation in size, form and use, through 
.the whole series, from the incisores to the molares. The cuspi- 
dati hold a middle place between the incisores and bicuspi- 



* Pronaque cum spectent anirnalia ccetera terrain ; 
Os homini s.ublim.e dedit : coelumque tueri 
Jnssit, & e rectos ad sidera tollere vultus. 

Ovidii Metamorphoseon^ lib. i. Jab. IT 



Temporary Teeth, §1 

des, and these latter teeth are in every respect intermediate 
between the cuspidati and the molares. The incisores are 
formed for catting the food, the cuspidati for tearing it, the 
bicuspides for tearing and grinding, the molares exclusively for 
grinding it. The incisores have but one root nearly round, 
and the body nearly flat with a cutting edge ; the cuspidati 
have also but one root, but it is longer and stronger than that of 
the incisores, the body is longer, rounder and its points conical ; 
the bicuspides of the upper jaw have two fangs, separated by a 
groove, that of the lower but one ; the body has two points, 
and more nearly resembles the molares, which complete the 
masticating surface. 

On viewing the teeth of both jaws, in their relative situation, 
when the mouth is closed, the incisores and cuspidati of the 
upper jaw, will be seen to project or rather shut over those of 
the lower jaw, so as partially to conceal them ; also that the 
external point of the inferior bicuspides will strike within the 
two points of those of the upper jaw. 

OF THE FORMATION OF THE TEETH. 

The formation of the teeth is a subject interesting to a per- 
son fond of natural history ; but as a full description would 
occupy too much space for the limits of this work, we shall 
merely give a brief outline. 

TEMPORARY TEETH. 

The rudiments of the temporary teeth can be distinguished 
very early in a foetus; as soon as the organization of its parts 
receive a determinate form. 

44 In a foetus of about four months old, the rudiments o^ the 
teeth may be very distinctly seen ; upon examining those sub- 
stances found in the jaws, they are seen to be soft, or pulpy 
bodies, bearing a resemblance to the figure of the body of the 
tooth to be formed, and each of them is contained in a mem- 
brane proper to itself, 



22 Natural History of the Teeth, 

" For some time during the formation of the teeth, the alveoli 
grow much faster than the teeth themselves, which are con- 
sequently but loosely contained within them. At the time of 
birth, the alveolar processes have increased so much, that they 
almost enclose or cover the teeth ; thus a firm support is given 
to the gums, and the infant is enabled to make considerable 
pressure in sucking, &c. without injury to the process which 
is going on underneath. 

** The ossification of the teeth begins to take place very early : 
it is first visible upon the tips of the incisores. In a foetus of 
about five or six months, ossification has commenced upon the 
pulps of the incisores and cuspidati, and on the points of the 
molares, this gradually advances and extends itself, over the 
pulp, down to the neck of the tooth, from the cutting edges or 
highest points, where it had first commenced. 

" At the time of birth, the bodies of ten teeth are distinctly 
formed in each jaw; these are the teeth designed to serve dur- 
ing the years of childhood, and are commonly called the tem- 
porary, shedding, or milk teeth. 

" After birth, as the ossification goes on, the teeth become 
too long to be contained within the alveolar cavity, they there- 
fore begin to make pressure upon those parts which cover 
them; this produces the process of absorption, which proceeds 
w r ith the enlargement of the tooth, first removing the mem- 
branes which enveloped the teeth, and afterwards the thick 
gum which covered them, this gradually becoming thinner 
and thinner, till at length the teeth are suffered to pass through. 
" The following is the order in which the teeth of a child 
generally appear. — The first teeth are the central incisores of 
the under jaw, one generally coming a few days before the 
other ; then, in the course of a month, the two central incisores 
of the upper jaw. These are succeeded in a few weeks by the 
lateral incisores of the under jaw, and then soon after by the 
lateral incisores of the upper jaw. The cuspidati are generally 
slower in completing their growth than the molares; they are 
placed deeper in the jaw, and therefore are preceeded by the 
first molares. The small molares of the under jaw usually 



Temporary Teeth. 23 

come before those of the upper; they commonly appear about 
the fourteenth or sixteenth month, and are soon met by those 
of the upper jaw. After these, the cuspidati come through, 
first in the lower jaw, and then in the upper. At some time 
between two years and two years and a half, the second mo- 
lares make their appearance, and thus complete the temporary 
set of teeth," 

In general, the first dentition commences about the sixth or 
seventh month. There is, however, great uncertainty in this 
respect. Instances are not wanting, where infants have been 
born with two or more teeth, whilst in many others, they have 
not made their appearance until as late as one two and even 
three years.* 

* SPORTS OF NATURE. 

Supernumerary Teeth. It occasionally happens that a temporary 
tooth, after having given off the rudiment for the permanent one destinid 
to succeed it, gives off a second process which produces a supernumera- 
ry tooth. These abortive productions are generally very irregular in 
their formations and give the mouth a disgusting and unsightly appear- 
ance. They are generally the production of the incisores of the upper 
jaw, though they occur in other parts of the mouth. 

Of a third set of teeth. " We sometimes though rarely," says 
John Mason Good, " meet with playful attempts on the part of nature to 
reproduce teeth at a very late period of life, and after the perma- 
nent teeth have been lost by accident or natural decay. 

"This most commonly takes place between the sixty -third and the 
eighty-first year, or the interval which fills up the two grand climacteric 
years of the Greek physiologists; at which period the constitution ap- 
pears occasionally to make an effort to repair other defects than lost 
teeth, on which we shall have occasion to treat more at large, when de- 
scribing that variety of decay, which in the present system is denomi- 
nated climacteric. 

" For the most part, the teeth, in this case, shoot forth irregularly, few 
in number, and without proper fangs, and even, where fangs are pro- 
duced, without a renewal of sockets. Hence they are often loose, and 
frequently more injurious than useful, My interfering with the uniform 
line of the indurated and callous gums, which, for many years perhaps, 
had been employed as a substitute for the teerh. A case of this kind is 
related by Dr. Bisset of Knayton, in which the patient, a female in her 
ninty-eighth year, cut twelve molar teeth, mostly in the lower jaw, four 
of which were thrown out soon afterwards, while the rest, at the time of 
examination, were found more or less loose. 

" In one instance, though never more than one, Mr. Hunter witnessed 
the reproduction of a complete set in both jaws, apparently with a re- 
newal of their sockets. 'From which circumstances,' says he, 'and 



24 Natural History of the Teeth* 

The following is Mr. Bell's table of the periods, between 
which the milk teeth are cut. 

From 5 to 8 months, the four central incisores, 
" 7 to 10 " the four lateral incisores, 
" 12 to 16 " the four anterior molares, 
" 14 to 20 " the four cuspidati, 
" 18 to 36 " the four posterior molares. 



another that sometimes happens to .women at this age, it should appear 
that there is some effort in nature to renew the body at that time.' " 

"The author of this work once attended a lady in the country, who 
cut several straggling teeth at the age of seventy-four ; and at the same 
time recovered such an acuteness of vision as to throw awaj her specta- 
cles, which she had made use of for twenty years, and to be able to read 
with ease the smallest print of the newspapers. In another case that 
occurred to him, a lady of seventy-six, mother of die late Henry 
Hughes, Esq. printer of the Journals of the House of Commons, cut two 
molares, and at the same time completely recovered her hearing, after 
having for some years been so deef as to be obliged to feel the clapper of 
a small hand-bell, which was always kept by her, in order to determine 
whether it rang or not. 

" The German Ephemerides contain numerous examples of the same 
kind ; in some of which, teeth were produced at the advanced age of nine- 
ty, a hundred, and even a hundred and twenty. One of the most singu- 
lar instances on record is that given by Dr. Siade, which occurred to his 
father; who, at the age of seventy-five reproduced an incisore, lost twenty- 
five years before ; and at seventy-seven reproduced another to supply a 
similar vacancy, so that at eighty he had hereby a perfect row of teeth 
in both jaws. At eighty-two they all dropped out successively; two 
yews aftei wards they were all successively renewed, so that at eighty- 
five he had once more an entire set. His hair at the same time changed 
from a white to a dark hue ; and his constitution seemed in some degree 
more healthy and vigorous. He died suddenly, at the age of ninety- 
nine or a hundred. 

" Sometimes these teeth are reproduced with wonderful rapidity; but, 
in such cases, with very great pain, from the callosity of the gums, 
through which they have to force themselves. The Edinburgh Medical 
Commentaries supply us with an instance of this kind. The individual 
was in his sixty-first year, and altogether toothless. At this period hi3 
gums and jaw-bones became painful, and the pain was at length excru- 
ciating. But, within the space of twenty-one days from its commence- 
ment, both jaws were furnished with a new set of teeth complete in 
number. 

" The jugglers on the continent, a century or two ago, were in the habit 
of taking advantage of this occasional playfulness of nature, and offering, 
as natural phenomena in the formation of teeth, singularities which na- 
ture never dreamed of. Thus a boy was at times started and hawked 
about the country with a golden tooth, much to the astonishment of both 
the learned and the unlearned : for though the tooth was in reality a 
natural one, and only covered over with an inlay of gold, yet the gilding 



Of tin Permanent Teeth. tS 

OF THE PERMANENT TEETH. 

The formation of the permanent teeth exhibits some of th^ 
most curious changes in the animal economy. The permanent 
teeth are produced from the sacks of the temporary ones by a 
process which reminds us of gemmiparous reproduction in the 
lower classes of animal and vegetable life. 

The investing sack of the temporary tooth gives off a small 
process or bud, containing the essential rudiments of the per- 
manent tooth, namely, th6 pulp, covered by its investing 
membranes- 

" It commences,'' says Mr. Bell, (i. e. the rudiment of the 
permanent tooth) n in a small thickening on one side of the 
parent sack of the temporary tooth, which gradually becomes 
more and more circumscribed, and at length assumes a distinct 
form though still connected by a peduncle (stem.) For a time, 
the new rudiment is contained in the same alveolus with its 
parent, which is excavated by the absorbents for its reception 
by a process, as far as I am acquainted unparalelled in the 
phenomena of physiology ; unless indeed the absoption of the 
roots of the temporary teeth may be considered as analogous. 
By degrees a small recess is formed by this peculiar process of 
absorption in the walls of the socket, in which the new rudi- 
ment is lodged, and this excavation continues to increase with 
the increasing size of the rudiment, whilst at the same time, 
the maxillary bone becomes enlarged, and the temporary tooth, 
advancing in its formation, rises in its socket, and the new cell 



was in one or two instances so exquisitely effected as to deceive almost 
every spectator, when the trick was first brought forward, and to lay a 
foundation for no small number of learned descriptions and profound ex- 
planations upon the subject.' 3 

I have repeatedly been informed that there is an old lady living at 
Athens, opposite Hudson, on the North River, Who lately cut a partial set 
of teeth at 83 ysars of age. I have not had an opportunity to enquire into 
the truth of this report, though from the respectability of my informants, 
I doubt not its correctness. Mr. Parmly mentions in his notes to Brown's 
Bentologia, that he has been repeatedly informed that there is a whole 
family, residing in South Carolina, who have never cut any teeth, the 
alveolar processes being so much elongated, as to obviate the deformity 
that would otherwise have been the consequence. 

2 



26 Natural History of the Teeth, 

is thus gradually separated from the old one, both by being 
itself more and more deeply excavated in the substance of the 
bone, and also by a deposition of a bony partition between 
them ; thus the rudiment of the permanent tooth is at length 
shut up in its own proper socket. There is not however, even 
now a total disunion between the two teeth, for as the tempo- 
rary one grows and rises in the jaw, the connecting cord or 
peduncle elongates; and although the sack from which it is 
derived, by degrees becomes absorbed, it still remains attached 
to the neck of the temporary tooth,* even long after the latter 
has pierced the gums ; and this connexion between the tempo- 
rary tooth, the permanent rudiment and the gum, is thus kept 
up by means of the cord, through a small opening in the top 
of the new alveolus, which is seen perforating the alveolar 
process, immediately behind each temporary tooth." ^ 

It is, impossible to give a correct idea of this curious process 
of nature without plates. The permanent incisores and cus- 
piclati, derive their rudimental processes from the same tempo- 
rary teeth, and are formed above them in the upper jaw, 
and below them in the lower. The permanent bicuspides 
are formed underneath the temporary molares, from which they 
spring. The second permanent molares derive their rudiments 
from the first, and the third, or wisdom teeth from the second. 

The first permanent teeth which begin to be formed, are the 
anterior molares ; at the time of birth ossification has com- 
menced on their extreme points; and between six and seven 
years of age, they generally make their appearance. When a 
child has cut all its temporary teeth, considerable progress has 
been made in the ossification of the permanent incisores, as 
well as the first molares. Between two and three years of age 
the child has cut all its temporary teeth ; at about six years, 
the permanent incisores and first molares are very far advanced 
in their formation ; and if none of the temporary teeth have 
fallen, there are at this time, no less than forty-eight teeth 



* This circumstance is of importance in the management of the second 
dentition, and will be mentioned under that head. 



Formation of ike Teeth. 27 

formed or being formed in the jaws, namely, twenty tempo- 
rary teeth and twenty-eight permanent ones, 

OF THE MANNER OF THE FORMATION OF THE TEETH. 

The teeth are formed in a manner peculiar to themselves, 
differing from the mode observed in the formation of all other 
bones. The pulp of the crown of a forming tooth is surround- 
ed by two membranes— an internal and an external. The 
internal membrane secretes the bony structure of the tooth in 
concentric layers or strata, one within another, first forming 
a shell of bone, of the shape o[ the crown. As the ossification 
goes on, the internal membrane contracts till the whole 
tooth is formed ; it then composes the nerve of the tooth, as it 
is commonly called; or in other words, it lines the cavity of 
the tooth, and forms a medium for the ramification of the dental 
nerves and vessels, which enter the cavity, through the fangs. 

As soon as a shell of bone has been formed on the pulp, the 
external membrane takes on a new action and secretes the 
enamel upon the bone. The deposition of enamel goes on 
till the tooth has made such progress as to cause the absorption 
of the membrane. The enamel, when it is first formed is 
quite soft ; it soon however grows hard and seems to undergo 
a process similar to crystallization, for it takes a regular and 
peculiar form. The enamel is composed of a great number of 
crystalline fibres, which are so arranged as to pass in a direc- 
tion from the external surface, to the centre of the tooth ; by 
this disposition of its fibres, the enamel acquires a greater de- 
gree of strength than could be obtained "by any other arrange- 
ment. When perfect, the enamel of a tooth is so hard, that in 
cutting it a file is soon worn smooth, and sparks may be elicit- 
ed from it with a bit of steel. The enamel is very thick on 
the grinding surfaces of the teeth and gradually grows thinner 
towards the gum, where it almost insensibly terminates. It is 
much thicker on the teeth of some individuals than upon those 
of others, also more compact. Sometimes it is defective in 
formation, being of a dirty yellow color and crumbling, or 



88 Natural History of ike Teeth, 

having spots on its surface. These spots* general are found 
in rows near the cutting edges of the incisores and grinding 
surfaces of the inolares, and are caused by irregular or defective 
action of the membrane which secretes the enamel ; and this 
morbid action is generally caused by some peculiarity of con- 
stitution or derangement of the system, at the time of its 
deposition. Thus, we sometimes find the enamel of the teeth 
of a whole family defective ; and again, the first teeth a 
child gets, will often be defective, while those that come in 
three or four years after will have the enamel perfect : 'we 
have seen many such examples. The teeth are more highly 
organized in some individuals than in others ; and with this 
organization, the constitution and state of the general system 
at the time of their formation, have much to do. 

PHYSIOLOGICAL OBSERVATIONS ON THE FOOD OP MAN. 
DEDUCED FROM THE CHARACTERS OF HIS TEETH. 

Physiologists have had much discussion, whether man be a 
carnivorous, omnivorous, herbivorous, or frugivorous animal, 
and have deduced their conclusions from the structure and 
shape of his teeth, by comparing them with those of the dif- 
ferent classes of animals, whose teeth are found to be adapted 
to the particular kind of food on which they live. Thus the 
carnivora have very long canine teeth, fitted for tearing the 
food in pieces ; the incisores and molares are also well adapted 
for the same purpose ; they have no lateral motion to the jaw 
and the enamel is confined to the external surface of the teeth. 

In the graminivora, especially the ruminantia, the incisores 
are fitted for cropping the grass, and the inolares for grinding 
it, and to render them better adapted for this purpose, their bony 
structure is intermixed with perpendicular layers of enamel, 
which, as the bone w r ears away, make the grinding surfaces 
very rough. All graminivorous animals have lateral motion 
to the lower jaw; the reason for this is plain. 

* Dental authors give us to understand, that as soon as the internal 
membrane has formed a shell of the crown of a tooth, that the external 
takes on a new action and secretes the enamel simultaneously from its 
whole inner surface. The phenomena occasionally displayed in the 
formation of the enamel, make it probable almost to a certainty, that it 
first begins to form, like the bone of the teeth on the points of the grinding 
surfaces of them, and then proceeds gradually towards the gum. 



Physiological Observations. 29 

The teeth of the omnivora are fitted for cutting, tearing and 
grinding. 

The teeth of all animals differ much in their shape and 
structure, and those teeth, for which an animal has the greatest 
use, are found to be more fully developed. The lion and 
tiger among the carnivora have long and terrible canine teeth. 
In the graminivora, especially the ruminantia, as the cow, these 
teeth are wanting, and the molares are the most conspicuous. 
In the rodmtia, or gnawing animals, as the beaver, squirrel, 
&c. the i?icisores are remarkably developed. 

In man* every part of the teeth appear equally developed, 
and exhibit a perfection of structure which may be considered 



* ff The teeth of men are distinguished by being all of one length, and 
by the circumstance of- their being arranged in an uniform unbroken 
series. The cuspidati are a little longer than the others at first; but 
their sharp points are soon worn clown to a level with the rest. In all 
animals the teeth of different classes differ in size and length, often very 
considerably"; and they are separated by more or less wide intervals : 
this is particularly the case with the teeth called canine, or cuspidati, 
which are long, prominent, and distinct from the neighbouring teeth ; 
their not projecting beyond the rest, nor being separated from them by 
any interval, is, therefore, a very characteristic circumstance in the hu- 
man structure. Even in the Simian, whose masticatory apparatus most 
nearly resembles that of man, the .cuspidati are longer, often very consid- 
erably longer, than the other teeth, and there are intervals in the series 
of each jaw to receive the cuspidati of the other. 

" The infer* ior incisors are perpendicular : the teeth, indeed, and the front 
of the jaw, are placed in the same vertical line. In animals, these teeth 
slant backwards, and the jaw slopes backwards directly from the 
alveoli ; so that the full prominent chin, so remarkable a feature in the 
face of our species, is found in no animal, not even in the Ourang-outang ; 
it appears as if the part were cut off. 

" The obtuse tubercles of the grinders are again very peculiar and cha- 
racteristic ; they are worthy of particular remark, because, being the 
great instruments of dividing the food, they correspond to the kind of 
nourishment which the animal naturally takes. Their surface does not 
resemble the flat crowns with rising ridges of intermixed enamel, belong- 
ing to our common herbivorous animals ; nor are they like the cutting 
tearing grinders of the carnivora, but they are well adapted to that mix- 
ed diet prepared by the arts of cookery, which man has always resorted 
to when he could get it, and when his natural inclinations have not been 
thwarted by the interference of religious scruples or prohibitions, nor 
opposed by his own whims and fancies. 

" The lower jaw of man is distinguished by the prominence of the chin, 
a necessary consequence of the inferior incisores bein<r, perpendicular, by 
its shortness, and by the oblong convexity and obliquity of the condyles, 



30 Natural History of the Teeth, 

the true type,* from which all others are mere deviations; 
hence by comparing the teeth of men, with those of other ani- 
mals, it is impossible to arrive, at any conclusion, as to what 



"On the subject of diet a question naturally presents itself; whether 
man approaches most nearly to the carnivorous or herbivorous tribes in 
his structure? What kind of food should we assign him, if we judged 
from his organization merely, and the analogy it presents to that of 
other mammalia? Physiologists have usually represented that our 
species hold a middle rank in the masticatory and digestive apparatus, 
between the flesh eating and the herbivorous animals;— a statement 
which seems rather to have been deduced from what we have learned by 
experience on this subject, than to result fairly frornan actual compari- 
son of men and animals. 

"The molar teeth being the instruments employed in dividing and prepar- 
ing the food, must exhibit in figure and construction a relation to the nature 
of the aliment. They rise in the true carnivora, into sharp pointed prominen- 
ces ; and those of the lower shut within those of the upper jaw ; — when 
the series is viewed together, the general outline may be compared to 
the teeth of a saw- These ammals are also furnished with long pointed, 
and strong cuspidati or canine teeth, which are employed as weapons of 
offence and defence, and are very serviceable in seizing and lacerating 
their prey; they constitute in some animals, as the lion, tiger, &c. very 
formidable weapons. The herbivorous animals are not armed with these 
terrible canine teeth ; their molares have broad flat surfaces, opposed in 
a vertical line to each other in the jaws. Plates of enamel are intermixed 
with the bone of the teeth in the latter, and as its superior hardness 
makes it wear less rapidly than the other textures of the teeth, it appears 
on the grinding surface in rising ridges, which must greatly increase the 
triturating effect. In carnivorous animals the enamel is confined alto- 
gether to the surface of the teeth. 

" The articulation of the lower jaw differs in the two cases as much as 
the structure of the teeth. In the carnivora, it can only move backwards 
and forwards, all lateral motion being prevented by the rising edges of 
the glenoid cavities : in the herbivora it has, moreover, motion from side 
to side. Thus we observe in the flesh-eaters, teeth calculated only for 
tearing, subservient, in parts at least, to procuring of food, as well as to 
purposes of defence ; and an articulation of the lower jaw, that precludes 
all lateral motion. In those which live on vegetables, the form of the 
teeth and the nature of the joint, are calculated (or the lateral or grind- 
ing motion. The former, having rudely torn and divided the food, swal- 
low it in masses ; while in the latter it undergoes considerable commi- 
nution before it is swallowed. The teeth of man have not the slightest 
resemblance to those of the carniverous animals, except that their enamel 
is confined to the external surface ; he possesses, indeed, teeth called 
canine, but they do not exceed the level of the others, and are obviously 
unsuited to the purposes which the corresponding teeth execute in car- 
nivorous animals. The obtuse tubercles of the human molares have not 
the most remote resemblance to the pointed projections of these teeth in 
carnivorous animals; they are as clearly distinguished from the flat 
erowns, with intermixed enamel, of the herbivorous molares, In the free 
* Thomas Bell 



Teething. 31 

class of animals he belongs or did belong when first created. 
Deprive man of the endowments of reason and make him fru- 
givorous, as some would have him to be, he must be confined 
as are the monkey species, to the tropical regions ; but reason, 
and his propensity to all kinds of food have enabled him to set 
climate at defiance, and to become the inhabitant of every 
region. 

TEETHING. 

The time occupied in the first dentition, is a critical period 
in the life of a child. The mortality* caused by the local irri- 



dom of lateral motion, however, the human inferior maxilla more nearly 
resemldes that of the herbivora. 

" The teeth and jaws of man are in all respects much more similar to 
those of monkeys, than of any other animals. A skull, apparently of the 
ourang-outang, in the Museum of the College, has the first set of teeth; 
the number is the same as in man, and the form so closely similar, that 
they might easily be mistaken for human. In most other Simian the 
canine teeth are much longer and stronger than in us ; and so far these 
animals have a more carnivorous character. The points and ridges of 
the molares in Simian, are distinguished by their sharpness, from the pe- 
culiar obtuse tubereles of the human molares, 

" We find, that whether we consider the teeth and jaws, or the imme- 
diate instruments of digestion, the human structure closely resembles that 
of the Simise ; all ef which, in their natural state, are completely her- 
bivorous. 

U I do not infer from these circumstances that man is designed by nature 
to feed on vegetables, or that it would be moreadvantageous to him to adopt 
that diet. The hands and the arts of man procure for him the food which. 
carnivorous animals earn by their teeth. The processes of cookery bring 
what he eats into a very different state from that in which it is employed, 
either by carnivorous or herbivorous animals. Hence the analogy in trie 
modes of procuring and preparing food is too loose for us to place much 
confidence in the results of these comparative views. We must trust to 
experience alone for elucidating the great problem of diet; its decision 
has been long ago pronounced, and will hardly now be reversed." — Law- 
rence's Lectures. 

* OPERATIONS 1 OF THE FIRST DENTITION. 

"1 have just said above, that the operation of the first dentition was so 
much the more difficult and attended with more danger, on account of 
the child being weaker and more nervous. It therefore will not be im- 
proper to begin with a statement of the situation, more or less favorable, 
of children, to enable them to endure the pain which i3 inseparable from 
that operation of nature, and to mark out a proper diet and regimen that 
will procure them a strong constitution. The first rule to be observed is 
that which is conducive to the enjoyment of a good state of health, which 



f£* Teething. 

ration of teething upon the general system is very great, and 
has been variously estimated by rnedleaj writers, from one 
third, to one half, and even two thirds of those that die under 
the age of two years. It is therefore proper and important, 
that every parent should be aware of the danger attendant on 

is the result of a well directed physical education. It is in the country 
especially, that children strongly constituted are to be met with, who 
undergo hardly any of tlae accidents of a painful dentition. This good 
state of Health is owing to the plain diet observed by the mother or the 
nurse, to the wholesome food she takes, to her rustie habits, in the strict 
observation ©f those laws that are prescribed by nature in the use of ne- 
cessaries, and in abstaining from whatever is proscribed. Her infant 
being under a similar influence, will, in conformity to two very simple 
reasons, enjoy a state of health most propitious to resist the infirmities to 
which nature seems to have condemned it from its birth. Are we desir- 
ous of obtaining sound minds ? we must begin by framing robust bodies 
by means of a good physical rearing. What I advance here is no para- 
dox, especially since the Author of "Emile' 3 has so eloquently refuted 
former prejudices against the masculine education so anxiously recom- 
menced oy the sages who have written on the first age of life. The re- 
sults of which I speak were remarkable among the most ancient people, 
even the most polished, provided they enjoyed a liberal government. 
The more we imitate the simplicity of nature, the more peaceably will 
her laws be accomplished, and the more will the improvement of our spe- 
cies be advanced ; in short, the nearer physical and moral man will reach 
%, high degree of perfection, the greater will be that quantum of happiness 
it is in his power tp attain. Let parents therefore attend wi|h affection- 
ate solicitude to the pkysical education of their children. Nature, which 
is never ungrateful, will repay them for their trouble, and amply remu- 
nerate the pi for haying helped her to form men at once useful to them- 
selves, to society, and more capable of enduring and resisting the miseries 
of human life. Let parents frequently call to their aid the advice of a 
respectable medical man, and by paying a due regard, give him a place 
among their best friends. That friend will recommend then* giving; 
their children only such wholesome food as may strengthen them, with- 
out fatiguing the organs of digestion, which are yet weak ; he will not 
fail to pay more attention to the quality than the quantity, for sobriety 
is, without contradiction, the parent of health. He will proscribe cakes, 
all sorts of sugar-plumbs, or too highly seasoned, and heating mside 
dishes; such fruit as is unripe and acid, and wbich so often deranges the 
digestion of children. He will advise, in addition, to use none but tem- 
perate drink, neither too Warm nor too cold. He finally will consider as 
an essential tiling, the free use in the open air, of their little limbs, yet in 
a feeble state. The happy state of health that will result from this regi- 
men will render the parent secure, because the cutting of the teeth will 
take place sooner, and without occasioning any remarkable irregularity 
in the organisation. The case will be quite different with weak and de- 
dicate children born of debilitated parents, or of a weak constitution. — 
Jj. t\ GerbauX) Pensioned Surgeon to the Civil and Military Hospi- 
tals of France, 



Teething. S3 

teething, in order that those remedies, which physicians have 
found to be most successful in affording relief, may be resorted 
to in time to avert the fatal consequences that too often follow. 
This is the more necessary as many parents are much prejudi- 
ced against the most efficacious treatment that has been em- 
ployed, and have some vague and erroneous notions on the 
subject : we therefore, shall give the opinions of two very 
eminent medical men, on this interesting subject, — the great 
John Hunter, and that very talented and learned physician. 
John Mason Good. 

The following is a condensed extract from Dr. Good's Study 
of Medicine, Vol. I. Diseases affecting the alimentary canaL 

" It will readily be supposed that the most violent symp- 
toms of dentition, are those produced by the growth and pro- 
trusion of the milk teeth ; for the system is then in its tenderest 
state of infancy, and prone to disorder from very slight causes 
of irritation. 

" The immediate cause of irritation in the present instance, 
is the pressure of the teeth in the gums; and the degree of 
irritation depends upon the peculiar temparament of the child. 
As the teeth push forward, the superincumbent gum wastes 
away in consequence of absorption, and is at last cut through, 
and the tooth makes its appearance. This pressure is not, 
however, uniformly exerted through the whole course of teeth- 
ing, but is divided into distinct periods or stages, by which the 
vital instinctive principle, which is what we mean by nature, 
becomes exhausted by a certain extent of action, and then re- 
quires rest and a state of intermission. The first active stage 
of teething is usually about the third or fourth month of infancy; 
and constitutes what is called breeding the teeth, or the pro- 
duction of their bone from their pulpy rudiments, buried in the 
gum, and formed during foetal life. The first and most usual 
symptoms of this change is the looseness with which the infant 
grasps the nipple, and the frequency with which it lets go its 
hold, accompanied with fretfulness and crying, and succeeded 
by a copious discharge of saliva, the salivary glands partaking 



34 . Teething. 

of the irritation of the gums. Next the uneasiness of the gums 
is founcj to be relieved by the pressure of any substance upon 
them, which obtunds their sensibility. Hence the child is fond 
of having its gums rubbed with the finger. If the irritation 
becomes very considerable, the gums swell, the child grows 
more fretful, and starts in its sleep ; or, on awaking suddenly, 
there is heat, thirst and other concomitant symptoms of fever, 
with perhaps dullness and drowsiness; looseness of the bowels 
is a usual sytfnptom, and a rash appears on the skin ; and if the 
irritation extends to the muscles of the chest, there is a dry and 
troublesome cough. In about ten days or a fortnight, these 
symptoms subside ; and though the infant may be occasionally 
teased, with slight paroxysms of uneasiness, it generally pas- 
ses off, without much inconvenience till the period of the second 
stage or cutting of the teeth. 

" At this time, the gum is often extremely sensible, and instead 
of being easied by the pressure of any hard substance, cannot 
endure the slightest touch. At the base, it is florid and dis- 
tended, but paler at the edge or upper part, and when the 
tooth is on the point of protrusion, seems covered with a flat 
and whiiish blister. The other symptoms are a repetition of 
tfyose just described, with a scabby eruption about the lips or 
head, and sympathetic inflammation behind the ears ; in bad 
cases, there are occasionally spasmodic movements of the 
mouth and jaws, convulsions and epilepsy. 

" The grand point here is to moderate the local irritation : 
a diarrhoea or a full discharge of saliva does this naturally, and 
hence these are favorable symptoms: and if the former be top 
violent, or accompanied with griping, it should be merely cor- 
rected by magnesia or prepared chalk. If the bowels be con- 
fined we must employ cooling laxatives; and the discharge of 
a small quantity of blood by lancing the gum freely, will often 
afford effectual relief. [The lancing of the gum is not the only 
cause of relief in this case, the membrane which has secreted 
the enamel often becomes dense and tendonous, and the gum 
swollen and irritated and both put upon the stretch, by the pro- 



Teething. 35 

truding teeth, and the lance takes off their tension, and 
often gives instant relief.] If the symptoms of oppres- 
sion be severe or incubent, as drowsiness, difficulty of breath- 
ing, stertor, or irregular motion of the jaws ; antimonial 
emetics and leeches should be had recourse to, and occasionally- 
repeated ; after which blistering will be found useful behind 
the ears or on the back ; and when the bowels have been 
thoroughly evacuated, the use of anodynes may be allowed, 
and generally prove highly useful, though they should be em- 
ployed with great judgment, and never trusted to nurses." 

" iVs far as my experience goes, says Mr. Hunter, to cut the 
gum down to the teeth appears to be the only method of cure. 
It acts either by taking off the tension upon the gum, arising 
from the growth of the tooth, or by preventing the ulceration 
which must otherwise take place. 

** It often happens, particularly when the operation is per- 
formed early in the disease, that the gum will reunite over the 
teeth ; in which case the same symptoms will be produced, 
and they must be removed by the same method. 

44 1 have performed the operation above ten times upon the 
same teeth, where the disease had recurred so often, and every 
time with the absolute removal of the symptoms. 

" A vulgar prejudice prevails against this practice, from an 
objection, that if the gum is lanced so early as to admit of a 
reunion, the cicatrized part will be harder than the original 
gum, and therefore the teeth will find more difficulty in pas- 
sing, and give more pain. But this is all contrary to facts ; 
for we find that all parts which have been the seat either 
of wounds or sores, are always more ready to give way to 
pressure, or any disease which attacks either the part itself 
or the constitution. Therefore each operation tends to make 
the passing of the teeth easier." — Hunter on the Teeth, p. 240. 

Professor John xlugustine Smith of this city in cases of diffi- 
cult dentition, recommends in his lectures, that the gum be 
cut off at once from the teeth, which will set them at liber- 
ty, remove all the symptoms of irritation, and prevent the 



'3G Teething. 

possibility of their recurrence, from the cicatization of the gum 
over them again. In a word lancing the gums in difficult 
dentition is practiced by all well informed physicians, and 
should be had recourse to early, in order to prevent the un- 
pleasant and often fatal symptoms that follow. 

Almost all infantile diseases are often induced by the irrita- 
tion of teething, as those of the head, bowels, and chest, the 
disease settling on the weakest part, or the part most predispos- 
ed to disease. We will not be surprised at this, when we con- 
sider the effects of similar irritation upon the adult — how little 
will derange his system, when predisposed to disease — the 
tender age of the infant — the irritability and mobility of its 
system. 

We would offer a few observations on the common practice 
of giving a childduring the first dentition something hard to 
bite upon, as coral, ivory, or a bit of wood. This custom was 
recommended by the old physicians, and is still by many on the 
supposition that such a substance is indicated by the constant 
desire of the child to put things into its mouth, and that it 
would facilitate the passage of the teeth through the gum, by 
the pressure the child exerts upon it, and thus obviate danger- 
ous symptoms. These opinions are founded in error : a hard 
substance cannot facilitate the passage of the teeth through the 
gum, unless it hastens its absorption, because, the crown of a 
tooth is formed first, and as the formation of the fang goes on, 
the tooth rises in its socket, and no pressure can hasten its pro- 
gress ; nature must have its course. On the contrary, the 
pressuie has a tendency to make the gum callous, or harden 
it, and thus acturaliy to impede the protrusion of the teeth, 
and make dentition more difficult : besides, the child is fre- 
cmently brusing the gum between the coral and teeth beneath, 
by accident, causing inflamation. A child during dentition 
has its finger constantly in its mouth, therefore the finger of 
the nurse is indicated, or any elastic substance, as a bit of india- 
rubber, 



Shedding of the Temporary Teeth. 37 

Dr. Blake says, " coral is a most dangerous weapon put into 
the hands of children to destroy themselves ; for as the teeth 
rise and become slightly elevated above the edges of the 
socket, those, hard bodies press and bruise the gum between 
them and the sharp points or edges of the teeth underneath : 
inflammation and its consequences follow, and in this way I am 
firmly persuaded the lives of thousands of children have been 
lost." 

SHEDDING OF THE TEMPORARY TEETH AND THE 
SECOND DENTITION. 

The falling out of the temporary teeth, to make way for the 
permanent set, is called shedding of the teeth, and the coming 
in of the permanent set, the second dentition. The necessity for 
the functions of the teeth commences as soon as the support 
from the mother ceases ; and hence nature prepares a tempora- 
ry masticatory apparatus, at an early period of life, which occu- 
pies but a few months in formation, and is destined to continue 
only a few years. The temporary teeth also, are proportioned 
to the size of the mouth : hence the necessity of a second set, 
of a larger size and of a more substantial structure, to serve 
during after life. 

The shedding of the teeth is one of the most curious opera- 
tions of nature. As soon as the permanent teeth begin to ad- 
vance to occupy the place of the temporary ones, their fangs 
are gradually absorbed* till nothing but the crown remains, 
when they fall out of the mouth. This circumstance accounts 
for the vulgar opinion that the temporary teeth have no fangs. 
If a temporary tooth be extracted while the process of absorp- 



* Absorption, (from absorbeo, to suck up ;) a function in an animated 
body, arranged by physiologists under the head of natural actions. It 
signifies the taking up of substances applied to the mouths of absorbing 
vessels; thus the nutricious part of the food is absorbed from the intes- 
tinal canal by the lacteals, (lac. milk, so called because the chyle or 
fluid they contain look3 like milk.) — Hooper's Med. Die. 



38 Natural History of the Teeth. 

tion is going on, the fang has the appearance of being broken 
off, or rather eaten away by insects. 

The period at which the shedding of the teeth, or the second 
dentition commences, is quite various; in some the process 
begins as early as the fifth or sixth year, and in others, not 
until the eighth : between the sixth and seventh years, may 
be taken as the standard time. The first four permanent mo- 
lares usually make their appearance before the temporary 
teeth begin to fall, and may be considered as an indication of 
the approaching change. 

Soon after the permanent molares have made their appear- 
ance, the two central temporary incisores of the lower jaw be- 
gin to loosen and fall out ; the permanent central incisores 
soon after appear : in two or three months the central tempo- 
rary incisores of the upper jaw become loose and drop out; 
aud are succeeded by the two permanent ones : in two or three 
months more, the same changes take place with the lateral 
incisores of both jaws, those of the lower jaws falling first: in 
about six or twelve months more the temporary molares fall, 
and are succeeded in due time by the permanent bicuspides t 
the temporary molares generally fall before the cuspidati or 
eye teeth, the long fangs of which require a longer time to be 
absorbed : the permanent incisores and cuspidati take the places 
of the same temporary teeth ; the permanent bicuspides, the 
places of the temporary molar es ; and the permanent molares, 
occupy the space made by the increase of the maxillary bones, 
after the completion of the first dentition. 

The following is Mr. Bell's table of the medium periods, at 
which the different permanent teeth are cut, but so irregular 
are they in this respect, that little dependance can be placed 
in such a statement. The table refers to the teeth of the lower 
jaw, which commonly precede those of the upper by two or 
three months. 

Anterior molares, 61 years. 

Central incisores, - - - - - 7 " 



Irregularities of the Teeth. 39 

Lateral incisores, ----- 8 years. 
Anterior bicuspides, - - - - 10 
Posterior bicuspides, - - - - 10 

Cuspidati, J 1—12 

Second molares, - - - - 12—13 
Third molares, (wisdom teeth) 17 — 19 



IRREGULARITIES OF THE TEETH. 

There is no part of the management of the teeth more de- 
serving the attention and care of parents, and of those 
entrusted with the charge of children, than that of irregulari- 
ties of the teeth; yet do part is so much neglected by them, or 
is so indifferently practised by the generality of the dental pro- 
fession. 

irregularities of the teeth are of such frequent occurrence in 
this country, and so productive of the diseases which invade 
them and the gums, and are so obnoxious to the person of nice 
feelings, that we wish especially to draw public attention to 
this subject. It is next to impossible to keep irregular teeth 
clean, and free of foreign matter, which lodges in their inter- 
stices, and, by its chemical action, destroys the enamel, and 
causes them to decay. Indeed, such teeth are almost sure to 
fall into decay, sooner or later : and the irritation of the foreign 
matter upon the gums is equally sure to engender disease in 
them also. 

We would endeavor to impress more strongly the impor- 
tance of this subject on the minds of our readers, inasmuch 
. as thereis neither "necessity or excuse for irregularities of the 
teeth, unless such be caused by accident; for it is quite in the 
power of the well-informed dentist to prevent or remove every 
irregularity, unless it be a sport of nature. And where such 
assistance is available, the parent who permits his child to 
grow up with deformed or irregular teeth, is justly chargeable 
of neglecting a duty to his offspring. It seems surprising that 



40 Irregularities of the Teeth, 

any parent can be so unmindful of the interest and welfare of 
his child, as to allow disgusting and hideous deformity to 
spring up and fix. itself permanently and irremediably on that 
excellent part of its person, which is a peculiar characteristic 
of man ; then to fix itself, too^where it must more or less dis- 
tort those features which are aptly said to be the index of the 
mind, and mar that visage which was made after God's own 
image : besides, there is even associated in our minds an idea 
of mental perverseness, when there is great deformity of the 
teeth. Notwithstanding all this, it frequently so falls out, 
either from ignorance of the means proper to be used for its 
prevention, or neglect or compassion on the child, or from 
what you will. Compassion for the child, or distrust enter- 
tained by the parent of the efficacy of the means recommended, 
we have often known prevent the necessary treatment for ob- 
viating irregularities of the teeth, and their consequences. But 
the former is altogether a misplaced sympathy, and the latter 
an ill-timed discretion, for the exercise of which, the child will 
not be over-grateful, when he shall have arrived to years of 
discretion, and to a state of irremediable and perfect deformity. 

The permanent teeth are often thrown into a great variety 
of irregular positions, by several causes obstructing their pro- 
gress during their irruption. 

A description of these irregularities is deemed unnecessary. 
The incisores and cuspidati of the upper jaw are most subject 
to them. 

CAUSES OF IRREGULARITIES OF THE TEETH* 

The first and most frequent cause is a want of simultaneous 
action between the protrusion of the permanent teeth, and the 
absorption of the fangs of the temporary ones. 

The second is a narrowness of the maxillary arch, or a want 
of exact proportion between the extent of it and the size of the 
teeth. 

These are the natural and frequent causes of irregularities, 



Irregularities of the Teeth. 41 

the removal of which, or the obviating of their effects, requires 
an operator having a minute knowledge of the natural history 
of the teeth, or of their formation and progress, that he may 
have an accurate knowledge of the means proper to be applied 
for their remedy. 

There is no department of the dental art in which so much 
ignorance is betrayed by the generality of operators, as in the 
management of the second dentition ; and none in which a lit- 
tle timely and judicious management will effect so much. We 
assert this from a sense of duty to our subject, and not from 
any illiberal feelings entertained towards the members of our 
profession. On the contrary, we shall be extremely happy on 
all occasions to extend the hand of fellowship to every worthy 
member of it. 

Most persons think, that ail that is required to obviate any 
irregularity, is the removal of some obstructing temporary 
teeth; and that this any person can do. But it is a gross er- 
ror. Many dentists are in the habit of recommending the ex- 
traction of the temporary teeth, previous to the irruption of the 
permanent ones ; and parents, indeed, often send their children 
to their dentist for the above purpose, thinking thereby to pre- 
vent irregularity. Nothing can be more empirical on the part 
of the dentist, or injudicious on the part of the parent, than 
such a practice — or more contrary to the law r s of nature ; be- 
sides the revolting cruelty of the practice. 

REASONS WHY THE ABOVE PRACTICE IS BAD IN THE 
EXTREME. 

First, it is contrary to the laws of nature, upon which we 
can never infringe with impunity. 

Second, there is a connexion existing between the temporary 
and the permanent teeth, by means of a cord extending from 
the neck of the former to the sack of the latter (see page 26,) 
which must be torn asunder, if the temporary teeth be ex- 
tracted, before the sack of the permanent one is absorbed ; 
therefore, the extraction of the temporary teeth would be very 
2* 



s 

4£ Irregularities of the Teeth, 

liable to interfere with the healthy and uniform deposition of 
the enamel; which process is not completed till a short time 
/ before the tooth cuts the gum. 

Third, the extraction of a temporary tooth before the perma- 
nent one has proceeded so far in its formation as in the case 
above, may prevent the completion of its formation altogether, 
by destroying or injuring the sack. 

Fourth, by the premature removal of the temporary teeth, 
the jaw is liable to contraction, from want of the accustomed 
support afforded to it by the teeth and by their sockets (which 
latter becomes absorbed whenever the teeth are removed;) 
consequently, when the permanent teeth come in, there will 
not be room in the jaw for them ; and thus irregularity is 
caused by the very means employed for its prevention. Mr. 
Bell mentions the case of a fine healthy boy, whose maxillary 
arch was well formed, being taken to a dentist, who, with great 
dexterity, removed eight teeth at once, all of which were firm 
in their sockets. The consequence was, that the permanent 
teeth were ultimately so irregular from want of room from the 
contraction of the maxillary arch, that it became necessary to 
extract four 'permanent hicuspides, to remedy the pernicious 
effects of this maltreatment. Thus, in all probability, four 
permanent teeth were sacrificed at the shrine of ignorance ; for 
Mr. Bell mentions that all the other members of the family had, 
regular teeth, though left entirely to nature. 

Fifth, it is a cruel and needless infliction of pain on a child. 
This notion of having the temporary teeth removed to make 
way for the permanent ones, is not uncommon. We have re- 
peatedly had children brought to us for this purpose. We trust 
enough has been said to convince the reader of the justness of 
our previous observation, that a man should thoroughly un- 
derstand his profession, who attempts the management of the 
second dentition. None of the temporary teeth* should ever 



* It often happens that the temporary teeth, especially the molar es, 
decay at an early age and expose the child to severe tooth-ache. ^ Under 
such circumstanees, it is common to extract the painful teeth, We think 



Irregularities of the Teeth. 43 

be extracted haphazzard ; let nature alone, if she is able to per- 
form her intents, for all her operations are perfection, if no 
casualty makes her deviate from her course : but if any of the 
causes before enumerated do obstruct the progress of the per- 
manent teeth, it is right and necessary to interfere. Whenever 
the following circumstances are found to exist at the period of 
the second dentition, we may with tolerable certainty form a 
favorable prognosis, as to the ultimate regularity of the teeth. 

First, if the parents of the child have regular teeth and have 
not required the assistance of art to make them so ; for this is 
an indication that the maxillary arch is well developed in the 
parents, and argues the probability of its being so in the child. 

Second, if the temporary teeth stand a little asunder, and 
especially, if they were originally crowded ; as this shows that 



the practice highly improper, as irregularities are often caused thereby ; 
and that the temporary molar teeth should never be extracted for tooth- 
ache, unless it proceed from inflammation, ulceration and the formation of 
gum biles; in which case, they should be removed for fear of mischief 
to the permanent teeth, which are being formed underneath them, as 
well as to rid the child o'f pain, incurable by other means. 

First, reasons have been previously given why the temporary teeth 
should not be extracted without occasion. (Sewages 26 and 41.) 

Second, the principal and more important reason is, that if the poste- 
rior temporary molar teeth be extracted, the first four permanent molares 
which the child usually gets at six or seven years of age, will be very 
apt to come forward, so as partially to occupy their places; the conse- 
quence will be permanent irregularity; for there will not be room ante- 
rior to the permanent moiares, for the permanent teeth springing from 
the temporary incisores, cuspidati and bicuspides ; and as tne incisores 
and bicuspides come in before the cuspidati, the irregularity will be very 
apt to happen to the latter teeth, to remedy which, will require the sac- 
rifice of the four posterior permanent bicuspides. 

We universally destroy the nerves of the temporary malar teeth for 
the cure of the tooth-ache, in preference to extraction ; and recommend 
the nurse to keep them stopped with gum mastic, or stop them ourselves 
with cement. The mastic answers a veiy good purpose, as it is insoluble 
in water, though the secretions of the mouth readily act upon it; it may 
easily be introduced into a hollow tooth after being softened in warm 
water. 

The nerves of the teeth may be destroyed as a general rule, w ithout pam, 
and without the least danger, by means of a very little arsenic, as Will 
be seen under the head " of stopping or plugging the teeth," 

Besides the prevention of the consequences before mentioned by the 
practice we recommend, the child often keeps teeth highly useful for 
mastication. 



44 Irregularities of the Teeth. 

there is a disposition in the jaws to expand, to make room for 
the increase of size in the permanent teeth. 

Third, if there be no prominence in the gum behind the? 
temporary teeth ; indicating that a permanent tooth is about 
to come through. 

In proportion as the above circumstances are found to exist, 
a more or less regular state of the permanent teeth may be 
anticipated. 

We shall not attempt a minute description of the means tp 
be used to prevent or obviate irregularities of the teeth. Out 
great, object has been to give the reader sufficient information 
on the subject to convince him of its importance, and to make 
it. plain what course is proper to be pursued. 

We would advise the progress of the second dentition to be 
carefully observed, and if the teeth should be- perceived to be 
coming in irregularly, application for the assistance of a well 
informed dentist in the case, and the child placed wholly under 
his management ; as it is to be supposed that he knows best 
what remedies are proper, and his reputation is pledged for the 
execution of his duty. 

In the treatmenHof irregularities of the teeth, reference 
should be had to the cause, and efforts rnade for its removal or 
to obviate its effects. 

When the irregularity is caused by a want of consentaneous 
action between the formation, or protrusion of the permanent 
teeth, and the absorption of the fangs of the temporary ones t 
the latter teeth should then be extracted without delay, when 
the permanent teeth will easily be brought into their proper 
position, by the frequent pressing upon them with the finger, 
or by a silken ligature, in such a manner as to aid them in ac- 
quiring a proper dentition. 

The earlier means are taken to remedy irregularities of the 
above kind, the better. Irregularities caused by conformation 
of the jaws and teeth are much more difficult to treat ; and 
often require the sacrifice of four of the permanent bicuspid 
teeth. The vicisores or cuspidati should never be extracted, if 
their extraction can be avoided, as on these teeth, the symme- 



Irregularities of th* Teeth. 45 

try and beauty of the mouth depend : it is rarely necessary, 
unless through gross neglect. As the i?icisores and bkuspides 
make their appearance before the cuspidati, these latter teeth 
are most frequently rendered irregular for want of room. It 
was formerly the practice to allow these teeth to grow down, and 
then to extract them ; but this was bad practice, as the cuspi- 
dati are the longest and strongest teeth in the head, and very 
useful for the support of artificial teeth in the event of the 
decay and loss of the incisores. It is better to extract either 
the posterior or anterior bkuspides, according to circumstances, 
when the cuspidati will soon fall down into their proper places. 

To remedy many cases of irregularities, it is necessary to 
have recourse to gold or silver plates, or other mechanical 
contrivances. When the front teeth stand too far asunder, 
from natural conformation, or from too early extraction of the 
temporary teeth, they may readily be brought into their proper 
position, by means of silken ligatures frequently renewed so as 
to exert a gentle but continued pressure. 

Irregularities of the teeth are occasionally produced by other 
causes than those that have been noticed. 

Supernumerary teeth — these teeth generally appear behind 
the incisores of the upper jaw and thrust them forward out of 
their places, and give the mouth a most unseemly appearance. 
The remedy is the extraction of them, as soon as they pierce 
the gum. 

Teeth are sometimes formed with ragged edges, or corners 
of them are broken off by accident : these irregularities are 
remedied by filing off portions from the cutting edges. This 
operation is not only useful by improving the appearance of 
such teeth, but is often necessary, for badly formed, projecting, 
or broken teeth are apt to occasion ulceration of the cheek and 
tongue ; it often happens that very useful teeth are extracted, 
when the judicious removal of portions of them, would have 
remedied the evil and preserved them. 

In conclusion of this subject, we would observe, that in a 
future part of this work, " on the prevention and treatment of 
the diseases of the teeth, " we shall have something very im- 



46 Irregularities of the Teeth. 

portant to say on the effects of crowded and irregular teeth in 
the production the above diseases, and the means to be used for 
their prevention. 

M The children for whom the assistance of the dentist is most 
frequently sought, are those who are either in a delicate, or at 
least an imperfect constitutional health ; where the state of not 
only the temporary teeth, but of the permanent also is to be 
considered ; and where both are found diseased, the future 
health and regularity of the latter requires the greatest consid- 
eration of the surgeon. 

" Irregularity of the teeth is one of the chief predisposing 
causes of their diseases, and never fails even in the most 
healthy constitution to destroy, sooner or later, the strongest 
and best set of teeth, unless properly attended to. It is thus 
not only & most powerful cause of destruction to the health 
and beauty of the teeth, but also to the regularity and pleasing 
symmetry of the features of the face; always producing, 
though slowly and gradually, some irregularity, but not un- 
Frequeatly the most surprising and disgusting appearance ; 
such as, distortion of the under jaw to one side, a great elon- 
gation of that jaw and the chin giving the face that grinning 
or ludicrous, and sometimes forbidding appearance, which be- 
comes particularly evident and characteristic at some future 
period of life. 

il It is, however, a great pleasure to know that Dental Sur- 
gery is abundantly provided with the most sure remedies ; and 
that, in the most delicate subjects, if placed under proper care 
at an early age, the. greater portion of the teeth of the perma- 
nent set may invariably be ^preserved in perfect health and 
regularity, in common with their relative and contiguous 
parts." — Koecker, p. 180. 

"The influence which the teeth exercise over beauty, justi- 
fies the pre-eminence which I 'attribute to them over all the 
other attractions of the countenance. This ornament is equally 
attractive in both sexes : it distinguishes the elegant from the 



Irregularities of the Teeth. 47 

slovenly gentleman, and diffuses amiability over the counte- 
nance, by softening the features. But it is more especially to 
woman that fine teeth are necessary, since it is her destiny 
first to gratify the eyes before she touches the soul, and capti- 
yates and enslaves the heart." (Diet. Sci. Med. Paris.) 



AN 



INAUGURAL DISSERTATION 



ON THE 



STRUCTURE AND DISEASES 



THE teeth: 



In America, no part of the human system is more subject 
to disease than the teeth; and the diseases of no part, we be- 
lieve are so easily prevented or cured, notwithstanding the 
contrary opinion generally obtains. 

In order to establish what we have asserted in the foregoing 
pages, viz. that the Jeeth of most persons may be preserved to 



* Reasons for re-publishing our Inagurual Essay. We deem it proper 
to mention the reasons that have determined us in republishing our in- 
augural discourse in this work. 

Firsts it is the ground work on which to raise our fabric ; or in other 
words, it contains" the fundamental principles on which the diseases of 
the teeth must be treated, that success may attend our operations. 

Second^ it discourses on subjects interesting to professional readers. 

Thirds many of our patients are anxious to be informed as to the 
causes of the diseases of the teeth ; hence, we infer that many of our 
readers will be pleased with our arrangement. 

Fourth) those who maynot have leisure or inclination to read a lengthy 
discourse, can pas the dissertation by ; hence too, we have arranged the 
whole work with as much system as possible, that the reader may obtain 
the information desired, under its appropriate head. 

We purposely leave out the exordium ; also, the concluding observa- 
tions, which are embodied in the work. 



Inaugural Dissertation. 49 

the end of life, it will be necessary to consider the disputed 
points in the structure and pathology* of the teeth. First, we 
will consider whether the teeth are organized and posses- 
sed of vitality, vascularityf and sensibility ; and secondly, 
whether caries originate internally, within the bony structure 
of the crowns of the teeth, from inflammatory action ; or ex- 
ternally, from chemical action of foreign matter and corrosive 
menstrua. 

All these points have been, and are still contested. The 
most eminent physiologists of the last and present century, 
who have paid any attention to the teeth, deny that their bony 
structure possesses either vascularity or sensibility : there are 
also a great variety of opinions as to the causes and 
origin of caries of the teeth. It may be proper for us to 
observe, in this place, that we believe the teeth to be 
organized, and possessed of vitality, vascularity and serv- 
sibility ; and subject to the same laws ot disease as the other 
bones of the human system, though modified by the cir- 
stance of a greater density in their structure ; and hence, that 
caries originates internally, from inflammation, and externally, 
from the chemical action of foreign matter : We think we 
have sufficient data in our possession to establish fully these 
positions* 

STRUCTURE OF THE TEETH. 

Are the teeth organized and living bodies, and possessed of 
vascularity and sensibility? 

Some physiologists have asserted, that the teeth possess 
none of these attributes, and have considered them as unorgan- 
ized bodies. 

To consider their arguments is unnecessary, since it has 
long been established that no inorganized body, or a body, 
destitute of vitality, can compose a part of an organized, living 



* Pathology, (a discourse on diseases,) the doctrine of diseases; 
f Vascularity , (vas } a vessel,) vascular, having vessels. 



50 Inaugural Dissertation. 

and sensitive system, or remain in contact with the living 
fibre, without exciting inflammation. Bead teeth and fangs 
invariably excite inflammatory action, by which, nature en- 
deavors to rid herself of the offending substance ; and she per- 
forms this process by causing an absorption of the alveoli, and 
a deposite of ossific matter at the bottom of the sockets, which 
gradually protrudes and removes the cause of irritation. 

The vascularity of the teeth has not been so well establish- 
ed. It is a subject, on which false opinions are generally 
entertained by medical men ; because, it scarcely falls within 
their province, and has with them, little interest or apparent 
utility ; so that the opinions of Hunter, Bell, and other eminent 
men, are at once embraced, without a proper examination of 
their merits. Nevertheless, it is a subject of much importance, 
in a country, where the diseases of the teeth are of such fre- 
quent occurrence as in America ; the truth of this assertion, 
we hope, will appear evident, in the course of this dissertation, 
for it is certain, that the pathology of these very important 
organs, must depend upon their organization ; therefore, we 
shall endeavor to establish the vascularity of the teeth, to the 
satisfaction of the most sceptical. 

We will mention the arguments, and assertions of those 
writers, who advocate the non-vascular structure of the teeth; 
and consider those arguments separately, how far they are 
tenable, and then adduce facts to refute them. 

Mr. Hunter was of opinion that the teeth are not vascular, 
and gives the following reasons : 

First — He could never inject the teeth. 

Second — He was not able to trace any vessels, going from 
the pulp, into the substance of the newly formed tooth. 

Third — A want of coincidence of phenomena between the 
teeth and other bones of an animal, known to be vascular, 
after having been subjected to the experiment of feeding upon 
food mixed with madder; for according to his experiments, 
those parts only, of the teeth formed while the animal is being 
fed with madder are colored red, while those parts previously 



Inaugural Dissertation, 51 

formed remain of their natural white color; and again, teeth 
once dyed with the madder do not lose the color by ab- 
sorption, while the other bones are readily colored during, and 
after their formation, though with the greatest facility, while 
the animal is young, and this color is again lost by absorption. 

Fourth — The teeth, he says, never change by age, and 
seem never to undergo any alteration, but by abrasion, w]^en 
completely formed ; they do not grow soft like the other bones, 
in mollities ossium.* 

" From these experiments," says Mr. Hunter, " it would 
appear that the teeth are to be considered as extraneous bodies, 
with respect to a circulation through their substance ; but they 
have most certainly a living principle, by which means they 
make a part of the body,' and are capable of uniting with any 
part of a living body." — Hunter's Natural History of the Teeth. 
Page 39. 

Mr. Charles Bell, who has paid considerable attention to 
the teeth, comes to this conclusion i 

" The phenomena displayed in the formation, adhesion, and 
diseases of the teeth, show them to be possessed of life, and 
they have a correspondence or sympathy with the surrounding 
parts ; but we are prepared to acquiesce in the opinion of Mr. 
Hunter, that they possess vitality, while yet they have no 
vascular action within them." — BelVs Anatomy. 

Mr. Lawrence, in a note appended to his translation of 
Blumenbach's Comparative Anatomy, has the following extra- 
ordinary passage. 

" The vascularity of the teeth is a doctrine refuted by every 
circumstance in the formation, structure and diseases of these 
organs. 



* Mollities ossium, (a softness of the bone.) "A disease of the bone, 
wherein they can be bent without fracturing them, in consequence either 
of the inordinate absorption of the phosphate of lime, from which their 
natural solidity is derived, or else of their matter not being duly secreted 
and deposited in their fabric. In rickets, the bones only yield and be- 
come distorted by slow degrees ; but in the present disease, they may bo 
at once bent in any direction". — Hooper's Med. Die. 



52 Inaugural Dissertation, 

Mons. deBlainville, a learned and popular French Zoologist, 
terms the teeth, "la partie mort." 

The facts and arguments, advanced by the advocates for the 
hon-vascular structure of the teeth, at a first view, appear con- 
clusive ; but on deeper investigation, this subject appears in a 
different light. It may be proper for us to observe, that most 
dental authors are of opinion, that the bony structure of the 
teeth is vascular. In order to place this subject in its true 
light, it will be necessary to examine the arguments on both 
feides of the question, 

MR. HUNTER'S REASONS FOR DOUBTING THE VASCU- 
LARITY OF THIS TEETH. 

"First," he says, "I never saw ttiem injected in any pre 
paration, nor could I ever succeed in any attempt to inject 
them, either in young or old subjects; and therefore believe 
there must have been some fallacy in the cases where they have 
been said to have been injected. Secondly, we are not able 
to trace any vessels going from the pulp into the substance of 
the newly formed teeth ; and whatever part of a tooth is form- 
ed, it is always completely formed, which is not the case with 
the other bones." — Hunter. Page 37. 

This inference is not just, though drawn by so accurate ari 
observer as Mr. Hunter. It is by no means conclusive, that a 
body is not vascular, because it cannot be injected ; as the 
serous part of the blood may be demonstrated to be circulating, 
by means of optical glasses, through vessels not perceptible to* 
the naked eye ; the bones of young animals are easily made 
red by injection, which is not the case with the bones of old 
ones; and as the tendons, ligaments, cartilages and crystalline 
lens cannot be injected, though believed to be vascular. 

■" Bat," continues Mr. Hunter, " what is a more convincing 
proof, is reasoning from the analogy, between them and other 
bones, where an animal has been fed with madder. The 
parts of the teeth already formed, do not become tinged with 
the dye, while those that are forming while the animal is being 



Inaugural Dissertation. 53 

fed witrf the madder, are dyed red ; and this color remains 
permanent." 

Mr. Hunter's experiments with madder indeed, seem a 
powerful argument in favoi\of his doctrine, nor have they yet 
been disproved, though it would appear so from the following 
extracts : 

" Mr. Hunter having observed that the teeth of animals fed 
with madder, did not become tinged so speedily as other 
bones; or, when tinged, that they retained their color longer, 
hence concluded, that they are to be considered as inorganiz- 
ed bodies, with respect to a circulation through their sub- 
stance.'" — Fox. Part II, page 1. 

" An incontestable proof of the presence of vessels, both 
circulatory and absorbent, and consequently of nerves, may be 
deduced from the progressive growth of the incisores in the 
squirrel tribe, and the coloring of the teeth of all animals, from 
feeding on food mixed with madder, and the subsequent loss of 
the acquired color from discontinuing the use of the madder.' 5 
—Blake's Essay on the Teeth of Man. Page 122. 

This was merely an inference by Dr. Blake, and w r as pro- 
bably deduced from his own experiments with madder, which 
must have satisfied him that Mr. Hunter's experiments were 
incorrect ; for he says in his work on the teeth, that he was 
engaged at that time, in the experimental investigation of the 
subject, and that he intended to make public the result ; but I 
cannot find that he ever put his intentions into execution. 

Mr. Hunter's experiments lose much of their force, since 
he does not inform us how long he continued them ; for it 
may require a longer time to effect these changes, viz. the 
coloring of the teeth of old animals, and the removal of the 
coloring by absorption from the teeth o[ young ones, fed with 
madder, than he allowed, on account of the great density of 
their structure. 

The following are the results of my own experiments on 
rabbits, fed with madder : 



54 Inaugural Dissertation. 

First— The teeth of young rabbits are colored red, in three 
or four weeks after the commencement of their diet. 

Second— If the madder be now omitted for ten weeks; at the 
end of this time, the coloring is absorbed, and the teeth regain 
their natural white color. 

Third— The teeth of old rabbits, fed with madder during 
four months are considerably tinged with the dye through their 
whole bony structure. 

We do not attach very great importance to these experi- 
ments, as it is evident from the structure and formation of the 
teeth of rabbits, that their growth is continuous as in the squir- 
rel tribe ; yet we think they serve to invalidate the experi- 
ments of Mr. Hunter, before mentioned. 

Again he says, " another circumstance in which the teeth 
seem different from other bones, and a strong circumstance in 
favor of their having no circulation within them is, that they 
never change by age, and seem never to undergo any change 
but by abrasion ; they do not grow soft as other bones do, as 
we find in some cases when the earthy matter has been taken 
into the constitution.' 7 

That the teeth do not undergo any change when completely 
formed, but by abrasion, is an assertion not founded on ob- 
servation. 

" It is always observed that as persons advance in life, their 
teeth lose that whiteness which they possessed in the time of 
youth. This change in the appearance of the teeth seems to 
depend upon one which takes place in their cavities, by which 
the vessels entering them are gradually destroyed, and the 
supply of blood proportionally diminished. In the teeth of 
persons advanced in years, the cavity is very frequently oblite- 
rated, in consequence of a deposit of bony matter, which en- 
tirely destroys the internal organization. When this happens, 
the teeth always lose their color, and become very yellow, 
their texture also becomes more brittle, and they acquire a 
horny transparency."— Fox' Natural History of the Teeth. 
Part II. page 24. 



Inaugural Dissertation. 55 

Tf, in general, the teeth do not suffer any change in molli- 
fies ossium and rachitis,* their very dense structure satisfactorily 
accounts for the fact. 

„ To the above arguments of Mr. Hunter, is added that of ex- 
foliation, f That the teeth do not exfoliate, we conceive not 
to militate at all against their vascularity, inasmuch as those 
bones which are the most vascular, exfoliate the most readily, 
as the bones of the extremities, while those of a more dense 
structure, exfoliate with more difficulty, as the bones of the 
skull. Thus, if a portion of the tibial be removed, it will 
granulate ; while a portion of the skull removed by the tre- 
phine]] is never regenerated. That the teeth do not possess 
sufficient vascularity to render them capable of exfoliation, we 
think a wise provision of nature ; for, had this been the case, 
the teeth would have been too soft to have performed their 
proper functions, and would have been more susceptible of 
inflammation and disease ; besides, who would, or could bear 
the torture, which the tedious process of the exfoliation of the 
teeth would occasion 1 

That the teeth possess sufficient vascularity, and have a 
circulation of the serous part of the blood through their bony 
structure, we judge from the following circumstances: 

First—It is impossible to conceive^ that any part of an ani- 
mal, or a vegetable, can exist and possess life, without a nutri- 
ent circulating fluid to sustain that principle. 

Second — The anatomy of the teeth themselves. The fangs 
of the teeth are surrounded and held in their sockets by a 
periosteum, § and as the periosteum of other bones transmits 



* Rickets. 

t Exfoliation, (from exfoliare^ to cast the leaf.) The process by which 
nature separates dead bone from the living, and supplies its place by a 
riewossinc formation. 
■ t Tibia. The shin bone or the largest bone of the leg. 

II Trephine. An instrument by which surgeons cut out round pieces 
cf the skull, for the relief of compression cf the brain. 

§ Periosteum, (about a bone.) The membrane which surrounds the 



Inaugural Dissertation. 

arteries and nerves to their substance, so, probably, does the 
periosteum of the teeth transmit minute arteries and nerves to 
their fangs, for the preservation of their vitality. This is the 
more probable, as the vitality of the fangs does not depend 
upon the internal membrane, as we shall shortly prove. Every 
Sooth has an internal cavity in some respects, of the shape 
of the tooth itself, lined with its proper membrane, to 
which an artery and a nerve are transmitted, forming, to- 
gether with the veins, absorbents and cellular substance, the 
pulp or internal membrane of the tooth, which adheres firmly 
to the walls of the cavity. Its blood-vessels are numerous, 
and large enough for the circulation of the red particles of the 
blood ; for in cutting off the crown of a carious tooth, the pulp 
of which is living, a small quantity of blood is usually dis- 
charged ; also, in removing the carious and dead portions of 
teeth, much decayed, for the purpose of plugging, the part 
near their internal membrane, will often appear reddish, from 
the blood-vessels of this membrane, shining through the thin 
layer of bone. If an aching tooth be extracted and split 
asunder, the pulp will always appear red and inflamed, and 
Jhe vessels so large, that they can be distinctly seen, ramifying 
through the whole pulp. 

44 A large quantity of blood is distributed to the teeth ; blood 
carries with it the principle of nutrition, and is sent only to 
those parts where renovation is necessary ; for what other 
reason then, but to impart some principle of nutrition, can so 
much blood be sent to the teeth." — Fax on the Teeth. Part II, 
page 34. 

44 The phenomena," says Mr. Charles Bell, 44 displayed in 
the formation, adhesion, and diseases of the teeth, show them 
to be possessed of life, and they have a correspondence or 
s}'mpathy with the surrounding parts. But we are prepared 



external surface of all the bones except the crowns of the teeth, and 
serves as a medium for the distribution of blood vessels to them, as well 
fur the attachment of the muscles, tendons, &c. 



Inaugural Dissertation. 57 

to acquiesce in the opinion of Mr. Hunter, that the teeth possess 
vitality, while yet they have no vascular action within them. 
We naturally ask, how can such vitality exist, independently 
of a circulation ? But there are not wanting examples of an 
obscure and low degree of life existing in animals, ova and 
seeds, for seasons, and if for seasons, why not for a term of 
years?" 

That there are animals existing wilhout a circulation, is an 
assertion altogether gratuitous. As for ova and seeds, we can 
percieve no analogy, for in them life is dormant, and remains 
in this state, till its proper stimuli call it into action, and if it 
now be stopped, it is destroyed forever. 

There may be animals existing for a season, without a circu- 
lation, as the frog, when frozen up in winter ; but this is a dif- 
ferent thing ; life, in this instance also, is dormant, and remains 
in this state, till the genial warmth of spring recalls it into 
action ; this however, has not the least analogy, as applied by 
Mr. Bell. A neutrient circulating fluid is the grand distinguish- 
ing mark, between the animal, vegetable and mineral king- 
doms ; as nothing can have life without this vital agent, and 
when it ceases, the animal or vegetable returns to its native 
elements. 

With due defference to the opinion of Mr. Bell, we do not 
believe, that the use of the internal membrane, is altogether to 
give to the tooth a sufficient degree of vitality, to prevent its 
acting as a foreign body, or that it is a means of fixing the 
tooth in its socket, for the healthy fang does not act as a foreign 
body ; but we believe that nature intends it to nourish the 
tooth, as well as to give it vitality and sensibility; and that 
for this purpose, it sends arterious and nervous fibres through 
its whole bony structure. That the internal membrane is not 
altogether intended to prevent the fang from acting as a foreign 
body in its sockets by giving it vitality, is proved by these 
facts : 

First — When the carious crown of a tooth has been cut off, 
and the perfectly healthy fang protected by a proper artificial 



58 Inaugural Dissertation. 

tooth from the action of external agents, this fang does not act 
as a foreign body, but will frequently last ten, twenty, or thirty 
years, and even more. 

Second — When caries has extended to the pulp of a tooth, if 
it be destroyed, and the tooth securely plugged, it will often 
remain firm and healthy in its socket for many years, provid- 
ed it be a tooth favorable to be operated on, the fangs healthy ? 
and its periosteum not inflamed. Of the truth of this, we have 
abundant testimony. 

Third — The cavity in the teeth of old persons, is frequently 
obliterated by a deposite of ossific matter, and this is always 
the case when they are very much worn down ; yet these 
teeth, although their internal organization is destroyed, do not 
act as foreign bodies. 

Fourth — On the contrary, in the diseases of the gum and 
sockets, when the teeth are protruding and hang loose by the 
end of the fangs, the internal membrane is frequently as heal- 
thy and sensitive as ever. 

It is said by all writers on the teeth, that whenever the 
internal membrane of a tooth is destroyed, the vitality of that 
tooth is also destroyed, and that it is a foreign and extraneous 
body in its socket ; but we apprehend the preceding facts prove 
this idea to be a mistaken notion ; and that the fangs them- 
selves possess a sufficiency of the vital principle, to prevent 
them from acting as foreign bodies, as long as their periosteum 
remains healthy. The vascular periosteum is firmly attached 
to the fangs, either by sanguiferous or other fibres ; and when 
inflammation has disorganized this connexion, then, and not 
till then, such teeth or fangs become foreign and extraneous 
bodies.* 



* This pathological fact, though it may be looked upon as trivial, is, 
nevertheless of much importance in the judicious practice of dental sur- 
gery, as it is evident that the dentist must be governed in his operations, 
by his views of the organization and structure of the teeth. Mr. Fox 
thought of curing aching teeth (the pain arising from the nerve) by d.s- 
loeation, so as to rupture the nerve and blood-vessels entering the fangs ; 



Inaugural Dissertation, 59 

Hence it appears that the use of the internal membrane, is 
designed for some other purpose, than that supposed by Mr. 
Charles Bell; and as the Great Architect of the Universe has 
made nothing without some purpose, it follows that the design 
of the internal membrane must be to nourish the tooth as well 
as preserve its vitality. If this were not the design, it is certain 
that it would have been better, if the teeth had been desti- 
tute of this membrane altogether, which is questioning 
Omniscience. This being granted, how can it be effected, 
unless arterious and nervous fibres, penetrate through the whole 
bony structure of the teeth 1 

The sensibility of the teeth, is also a sound argument in 
favor of their vascularity: of the sensibility of the teeth, every 
one must be convinced; many persons experience pain in 
having the carious and dead portions of their teeth exfoliated, 
far from the internal membrane, and the nearer we approach 
this membrane, the more acute is the pain. 

" It often happens that in consequence of the use of mercu^ 
ry, or from dyspeptic affections, the gum and the edge of the 
alveolar process recede from the neck of the tooth, which thus 



but he soon found his patients returning with inflammation in the sockets 
of such teeth, which he supposed was owing to their having become 
foreign and extraneous bodies, from the destruction of the internal mem- 
brane. But it was rather owing 1 to the disorganisation of the periosteum 
— the total destruction of vascular and vital connexion between the 
periosteum and the fangs. 

Had Mr. Fox destroyed the internal membrane, without injuring the 
periosteum, and securely plugged these teeth, he would have preserved 
most of them for many years. 

One dentist pulls out his patient's front teeth or fangs, and substitutes 
artificial teeth on plates, and thus gives him much pain and inconven- 
ience, and endangers the premature loss of the adjoining teeth. Another 
curs off the stumps of the same teeth even wiih the gum, and splices on 
to them the crowns of other teeth, with little pain to his patient, which 
are as convenient and nearly as useful as the original teeth ; and the 
stumps thus protected, will last for many years. Indeed, the former and 
wretched practice is, at this time pursued by very respectable dentists in 
this country. Again a person who has been so unfortunate as to lose 
most of his teeth, goes to one dentist who pulls out his aching tooth, 
while another would" easily have destroyed the pulp, plugged it, and 
thus preserved a highly useful tooth. 



60 Inaugural Dissertation. 

becomes exposed, and if this part be then touched with the 
point of any instrument, pain is immediately produced, which 
is always increased when the part is inflamed. " — Thomas Bell 
on the Teeth. Page 13. 

Sometimes teeth affected with the denuding process, or some 
species of caries, are exquisitely sensitive; and it is remarka- 
ble that as the diseased parts are removed with instruments, 
the pain diminishes as we reach the sound bone. These facts we 
conceive, prove that nervous fibres must traverse every part 
of the bony structure of the teeth ; and that their extremities, 
bordering on the diseased parts, are inflamed or morbidly sen- 
sitive : and that the pain cannot arise directly from the inter- 
nal membrane, from sympathy or concussion as supposed by 
Richerand and some other physiologists. This is the more 
probable, as it is impossible to conceive that a part of our sys- 
tem, to which no nerves are distributed, (if there be such parts) 
can communicate to the sensorium the sensation of pain. This 
hypothesis can certainly require no further refutation. This 
being- granted, it is repugnant to sound reasoning to suppose 
that vascular fibres do not also accompany the nervous fila- 
ments. 

Again, after a tooth has been plugged, the patient usually 
experiences some pain when he takes any thing hot or cold 
into his mouth, for two or three weeks after the operation, 
on account of the metal being a better conductor of caloric 
than bone is ; the nerve at length becomes accustomed to the 
sudden transition of temperature, and no further inconvenience 
is experienced. May not this phenomenon be rather owing to 
some change in the organization of those parts of the teeth, 
surrounding the plug? and is it not probable, that this change 
is a recession of the arterious or nervous fibres, and deposition 
of ossific matter in their minute canals ? 

Finally, the phenomena displayed in the diseases of the 
teeth, are powerful and conclusive arguments in favor of their 
vascularity ; for we shall hereafter show that the constitutional 
formation of the teeth, climate, great and sudden changes of 



Inaugural Dissertation. 61 

temperature, manner of living, and diseases of the general 
system, have a great effect in inducing the diseases of the 
teeth, as we have an abundance of facts to prove : these 
certainly can have no such effect, every medical philosopher 
will assert, unless the teeth are susceptible of inflammation, 
which cannot be unless they are vascular. 

So much for arguments and facts combined. We appre- 
hend that the following facts will satisfy any man that the 
bony structure of the teeth is vascular. 

In the spasmodic cholera the teeth are said to be frequently- 
injected with the red particles of the blood, particularly by the 
French physicians : our own observations will not permit us 
to bear testimony in favor of this assertion, though we do not 
doubt but that it does happen. 

"I have at this time five teeth taken from the jaws of a very 
plethoric woman, who died of a violent inflammatory fever, 
which appear completely and beautifully injected with red 
blood. "—Fitch on the Teeth. Page 135. 

" I have frequently examined the teeth of persons, whose 
death had been caused by hanging or drowning, and have in- 
variably found the teeth of a dull deep red, which could not 
possibly be the case if these structures were devoid of a vascu- 
lar system." — Thomas Bell on the Teeth. Page 12. 

Dr. J. R. Spooner of Montreal* has had several opportuni- 
ties of examining the teeth of persons who have died on the 
gallows, and has invariably found the phenomena mentioned 
by Mr. Bell, 

We have in our possession several teeth taken from the jaws 
of a man who was hanged, the whole bony structure of 
which is red with blood. 

Many more arguments and facts might be adduced in proof 
of the vascular structure of the teeth ; but we trust enough have 
been advanced to establish it fully. W r e have even dwelt 
longer on this subject than may be thought necessary ; if so, 
a desire to establish our position beyond a doubt, is some apo- 
logy ; for if our views be incorrect our practice must also be 



62 Inaugural Dissertation* 

incorrect, as to the judicious treatment of the diseases of the 
teeth must depend upon the structure and pathology of these 
organs. 

A great variety of opinions have been and are still entertained, 
whith respect to the origin of decay of the teeth. Some of 
these opinions have arisen from the views of their authors, on 
the subject we have been discussing ; others from no views at 
all, but rather from hypothesis. 

The treatment of the diseases of the teeth is equally various, 
and for the same reasons ; for, as before observed, one practi- 
tioner pulls out his patient's stumps of teeth, and substitutes 
the crowns of other teeth on plates ; another files off these 
stumps even with the gum, and splices on to them the crowns 
of other teeth ; the one saves all the teeth he can, the other 
extracts indiscriminately all that are painful. One dentist 
files asunder those teeth that are crowded together and begin 
to exhibit symptoms of decay, another condemns the practice as 
injurious. One man plugs a tooth without half removing the 
decay, another knows that if he does not perfectly extirpate it, 
he does not cure the disease; in a word, the whole treatment 
of dental decay, both preventive and curative, and indeed, of 
all the diseases incidental to the teeth, must be founded on the 
subject we have been discussing, if much utility can be deriv- 
ed or expected. 



DISEASES OF THE TEETH, 



1st. — Caries. — Two species. 1st, internal 2nd, external. 

2nd.— Odontitis. 

3rd. — Periostitis. 

4th. — Exostosis. 

5th.- — Necrosis. 

6th. — Denuding Process of Hunter. 

7th. — Abrasion. 

Of these diseases caries, or as Mr. Thomas Bell terms it, 
gangrene of the teeth is the principal ; and as it is a disease 
of very frequent occurrence in our country, we shall examine 
it thoroughly. 

Caries has been divided by writers upon the teeth, into su- 
perficial, when the disease first makes its appearance on the 
outside of a tooth- — deep-seated, when it has extended to the 
internal bony structure of a tooth — simple, when the disease 
has not reached the internal membrane — complicated, when 
it has extended to this membrane — and into internal and ex- 
ternal caries. There can be no utility in this arrangement 
for our purpose, as it is a sub-division of the same disease. 
There are also, several species of caries, but as they originate 
from the same causes, and require the same treatment, it would 
be foreign and surperfluous to treat of them separately ; there- 



G4 Diseases of the Teeth. 

fore, we prefer the division into internal and external caries, 
as more useful, and founded on the anatomy of the teeth, and 
as we believe, on the true pathology of this disease. 

Various opinions have been entertained, as to the origin and 
causes of caries, from the time of Mr. Hcnter down to the 
present day ; and we beg leave to present some of the opinions 
of the most celebrated writers upon the teeth, in their own 
words. Mr. Hunter says : 

44 The most common disease to which the teeth are exposed, 
is such a decay as would appear to deserve the name of morti- 
fication. But there is something more ; for the simple death 
of the part would produce but little effect, as we find the teeth 
are not subject to putrefaction after death ; and therefore I am 
apt to suspect that, during life there is some operation going on 
which produces a change in the diseased parts. 

44 It does not arise from external injury, or from menstrua, 
that have the power of decomposing part of the teeth ; for any- 
thing of that kind could not act so partially. We may reasona- 
bly suppose that it is a disease arising originally in the tootli 
itself."— Hunter's Natural History of the Teeth. Page$ 
135, 141. 

Mr. Fox thus gives us his opinion : 

44 The causes of caries have not been satisfactorily explain- 
ed, from the structure of the teeth not having been duly con^ 
sidered. Mr. Hunter says : — ' It does not arise from external 
injury, or from menstrua, which have a power of dissolving 
part of a tooth ; but we may reasonably suppose that it is a 
disease arising originally in the tooth itself.' It is surprising 
that, although Mr. Hunter went thus far, he gave no correct 
idea of the manner in which the disease can alone originate. 

44 The proximate cause of caries appears to be an inflam- 
mation in the bone of the crown of the tooth, which, ori 
account of its peculiar structure, terminates in mortifica- 
tion. 

44 The membrane which is contained within the cavity of 
a tooth is very vascular, and possesses a high degree of nerv- 
ous sensibility ; an inflammation of this membrane is liable to 



Diseases of the Teeth. 65 

be occasioned by any excitementrwhich produces irregular 
action ; and as the bone of the tooth is very dense, and posses- 
ses little living power, a death of some part of it may speedily 
follow an inflammation of the vessels of the membrane which 
are contained within the cavity. 

" If a sound tooth that has been recently extracted be broken, 
the membrane will be found to be firmly attached to the bone 
of the tooth, forming the inner cavity. But when this mem- 
brane becomes inflamed, it separates from the bone, and the 
death of the tooth is the consequence. 

" That this is the proximate cause of caries, appears to be 
highly probable by remarking that a caries of other bones is 
caused by a separation of those membranes which cover them, 
and which are attached to them. Thus a separation of the 
periosteum will cause a death of a part of the tibia, or that of 
the pericranium, a caries of some part of the bones of the head. 

"This opinion is also confirmed by comparing the symp- 
toms which accompany inflammation in a bone with those 
which are occasionally felt by persons in their teeth, previously 
to any appearance of caries. 

"During the inflammation of a bone, there is an obtuse, 
rather than an acute pain ; the parts which surround or cover 
it feel sore, and cannot bear pressure ; and when there is an 
opportunity of making the comparison, an inflamed bone is 
found to have a darker appearance than a healthy one. 

" Very similar to these are the symptoms which are ob- 
served by every one when their teeth have been affected by 
what is eornmonty termed a cold. At this time a dull, uneasy 
pain is felt extending along the jaw, the teeth are tender, and 
cannot be pressed together with the ordinary degree of force; 
and it may almost always be observed, that the teeth thus 
affected, have a darker appearance than these which are per- 
fectly free from pain. 

" When these inflammatory symptoms subside, the pain in 
the teeth goes off; but, as inflammation may have caused a 
death of some part of one or more teeth, the decomposition of 

3* 



60 Diseases of the Teeth. 

the internal part of the tooth goes on, until the enamel is broken 
away, and a caries is discovered. 

" I could mention many cases in corroboration of this state- 
ment, and produce several examples of teeth with the decay 
extending through the internal part, whilst the enamel re- 
mained perfectly sound." — Fox's Natural History of the Teeth. 
Part II, page 11. 

Mr. Thomas Bell, who has written the best work upon the 
teeth observes : 

" It is I believe, only by recurring to the vitality of the 
teeth, modified as it certainly is by the peculiarities of their 
structure, that we can arrive at the true explanation of the 
nature, the cause and the progress of dental gangrene. Mr. 
Fox, apparently from his well intended, but overweening 
fondness for discovering in the diseases of the teeth a perfect 
analogy with those of other bones, was led to form incorrect , 
notions on this subject, though it is to him that we are indebted 
for the actual discovery of the cause of this disease. He says, 
' when the membrane becomes inflamed, it separates from the 
bone, and the death of the tooth is the consequence. That 
this is the proximate cause of caries,' he continues, * appears ■ 
to be highly probable, by remarking that a caries of other bones 
is caused by a separation of those membranes which cover 
them, and which are attached to them. Thus a separation of 
the 'periosteum will cause a death of part of the tibia ; or that, 
of the pericranium,* a caries of some bones of the head.' Ex- 
clusive of the circumstance that caries is, in this passage con- 
founded with necrosis, it contains in every respect, a false 
view of the question. It is extraordinary that this author, 
arriving as he did at so near an approximation to the true 
cause of the disease, should have at once confounded not only 
caries with gangrene, but partial gangrene with the total death 
of the tooth. If inflammation go on to such an extent as to 



* Pericranium, the membrane which invests the external surface of 
the skull. 



Diseases of the Teeth. 67 

occasion the separation of the membrane — the loss of the me- 
dium of organic communication between the tooth and the 
general system — the whole tooth loses its vitality at once, and 
becomes an extraneous body in the socket ; under which cir- 
cumstances, it indeed gradually assumes a darkened color, 
but without any of those appearances which characterize the 
disease in question. 

11 Still however, the true proximate cause of dental gangrene 
is inflammation; and the following appears to me to be the 
manner in which it takes place : when from cold or from an}' 
other cause, a tooth becomes inflamed, the part which suffers 
the most severely is unable, from its possessing comparatively 
but a small degree of vital power, to recover from the effects of 
inflammation, and mortification of that part is the consequence. 
That the bony structure of the teeth is liable to inflammation, 
appears not only from the identity of the symptoms which take 
place in them when exposed to causes likely to produce it, 
with those which are observed in the other bones when inflam- 
ed, but more conclusively still from the fact already mentioned, 
that teeth are occasionally found, in which distinct patches, 
injected with red particles of blood, have been produced by this 
cause, after the continuance of severe pain. A tooth which 
has been the subject of inflammation, will often remain with- 
out any diseased appearance for weeks or months afterwards; 
but at length the consequence which I have described becomes 
obvious, by the occurrence of a darkened spot which shows 
itself through the enamel; and the gradual destruction of the 
tooth follows, if means be not taken to arrest its progress." 

Mr. Bell goes on, and gives as his opinion, that caries of the 
teeth, is always produced by inflammation; and that it inva- 
riably commences immediately under the enamel; which he 
argues is the more probable, as this part of a tooth is furthest 
from the internal membrane, and in consequence of it posses- 
sing less vitality, has less power of resisting inflammatory 
action. 

The causes of caries, he devides into predisposing, remote 



08 Diseases of tin Teeth, 

and exciting. By predisposing causes, he means all those 
circumstances, which may affect the structure of the teeth, 
during their formation. By remote, those things which may 
produce a subsequent change in their condition ; as the adminis- 
tration of certain medicines ; and by exciting causes, those things 
which directly act on the teeth ; as cold, great and sudden 
changes of temperature, foreign matter, &c. It is seen, that 
the views of Mr. Bell are materially different from those of 
Mr. Fox, on this subject; the latter gentleman divides caries 
into internal and external, and supposes that internal caries i3 
produced, by an inflammation of the internal membrane, which 
occasions it to separate from the walls of the cavity, and that 
the death of some portion of the bone of the tooth is the conse- 
quence. This hypothesis can certainly require no refutation; 
the internal membrane is never separated from the walls of the 
cavity, unless suppuration has taken place, no matter how 
much the tooth may be decayed, as any one may satisfy him- 
self, by examining the interne! membrane of a tooth, recently 
extracted, which will be found to adhere with some firmness. 
Externa! caries, Mr. Fox attributes to the action of foreign 
matter and corrosive menstrua, which destroy the enamel and 
expose the bone of the teeth to decay. 

Mr. L. S. Parmly and others, deny that caries ever origi- 
nates internally, from inflammation, and declare that it is pro- 
duced in all cases, by the action of foreign matter, corrosive 
menstrua, and the putrefactive fermentation of the particles of 
food, lodged between the teeth. 

Mr. E. Parmly, of this city, is of the above opinion. He 
says: 

*"' I consider the immediate and exciting cause of dental decay 
to be always external to the tooth itself, and to consist of cer- 
tain corrosive menstrua to which these organs are exposed 
from bodily disease, improper aliments, powerful medicines, 
and the thousand other sources of acrid filth and destructive 
poisons that become concentrated in the mouth and deposited 
upon the teeth. These procuring causes of caries may indeed 



Diseases of ihe Teeth, 6D 

derive their origin from constitutional diseases acting upon the' 
system at various periods of life, but whatever internal defect 
of structure a tooth may derive from original organization, 
how much soever it may be predisposed to take a diseased ac- 
tion under favorable conditions, still, the tooth never decays till 
exteranlly affected by putrescent, or corrosive, or disorganizing 
matter, which breaks up its structure."— Notes on Brown r $ 
Dentologia. Page 135. 

Dr. Fitch, of Philadelphia, who published a large work upon 
the teeth, a few years ago, is of opinion, that caries commences 
on the outside of the teeth. He observes: 

4i I can easily conceive of causes acting upon the teeth ex- 
ternally, to produce their decay — of constitutional and local 
causes, which affect their living powers and organization inter- 
nally. But to conceive of a latent cause which acts upon the 
substance of the bone of the tooth, without relation eiiher to 
its nerve or blood-vessels, or its lining membrane on the inside, 
or to any deleterious influence on the outside, is a stretch of 
conception which I can hardly form ; still I will not deny but 
that it may be. If so, why are not the fangs as often affected 
as the crowns of the teeth ? The only answer I can make is, 
that those who advocate the first idea as a common principle, 
have either mistaken themselves in their statements, or they 
have 'mistaken this subject in its true pathology."— Fitch on 
the Teeth. Page US. 

By all this ambiguity, Dr. Fitch evidently means that he 
cannot conceive, how caries can originate iuternally, from in- 
flammation of the bone of the teeth, although he is a stren- 
uous advocate for the vascularity and sensibility of the teeth, 
and contends that the proximate cause of caries, is inflamma- 
tion of their bony structure, and avers the predisposing causes 
of caries. — See Fitch on the Teeth. Page 143 to 160. 

That the fangs are not liable to decay is explained by the 
the circumstance of their being protected in their situation, by 
their structure and periosteum. 

44 Numerous causes have been assigned, as the origin of 



70 Diseases of the Teeth. 

decay in the teeth, such as scurvy, heat of stomach, heat of 
the mouth, nervous fever, acidity of the saliva, &c, none of 
which appear sufficient to account for caries. 

"From a careful attention to circumstances, caries will be 
found not to be so much the effect of chance as is generally 
imagined ; it appears almost universally, to be an original 
mischief implanted during the formation of the teeth." — Fuller 
on the Teeth. Page 48. London, 1815. 

" Heat, to a certain degree, is highly detrimental to the 
teeth ; hence we find that those animals, which live chiefly on 
hot food, are most subject to caries of the teeth. Increased cir- 
culation in the gums, whether the effect of mercury or general 
fever of the system, is also very injurious to teeth, and hence 
caries of the teeth are a common consequence of salivation 
and inflammatory fever." — Familiar Dissertation on the Causes 
and Treatment of the Diseases of the Teeth. By J. P. Hertz. 
London, 1815. 

Mr. Murphy thus gives us his opinion"on this subject : 

" No medicine has yet been discovered, which will prevent 
caries of the teeth, or which will effectually operate as a cure 
nor is the cause from which it originates positively ascertain- 
ed." — Natural History of the Teeth, fyc. Page 76. London, 
1811. 

Mr. Bew thus advances his ideas as a new and very impor- 
tant discovery : 

" In offering this portion of my opinion on the maladies in- 
cidental to the teeth, I am well aware that I am rending the veil 
from a treatment that I have long contemplated in theory, and 
reduced to practice with the happiest success during many 
years; 1 tread on ground untrodden before, and open a wide 
field for the contemplation of the philosopher in the anatomy 
and pathology of these organs of mastication. 

" To those who casually glance at the teeth primary and 
permanent, with healthy gums, fitly arranged in their several 
sockets for the purpose of mastication, aided by the conviction 
of sight and feeling, that they are the hardest substances in 



Diseases of the Teeth. 71 

our system. ; how inexplicable and irreconcilable to credibility, 
must it appear that these very hard substances, with their, flinty 
coatings date their destruction from completion by lateral pres- 
sure against each other." — Opinion's on the Causes and Ef- 
fects of Diseases in the Teeth and Gums, By Charles Bew. 
London, 1319. 

Mr. Wooffendale, speaking of the imperfect appearances of 
the teeth, (defective enamel) advances the following ridiculous 
idea : 

44 1 have been at some pains, (and I believe my endeavors 
have not been in vain,) to ascertain a cause for these imperfect 
appearances in the teeth. 

"I have frequently seen these marks, both on the first and 
second sets of teeth, which cause me to supect, that such child- 
ren have had the small-pox twice." — Observations on the 
Teeth. 1800. 

M. Gerbeaux, of Paris, remarks : 

44 People who inhabit cold, moist, and marshy countries, 
have rarely good teeth. 

44 It ought perhaps to be remarked, that diseased teeth, 
among many individuals, originate in organic disposition, 
which may be transmitted hereditarily from parents to their 
children."— Observations on the most frequent Diseases inciden- 
tal to the Mouth. Page 14. 

M. De Chemant acknowledges his ignorance of the causes 
of caries, in these words : 

44 Unfortunately all the researches that have been made on 
this subject, have hitherto remained fruitless, because, in the 
present state of our knowledge, we cannot foresee the disor- 
ganization of the teeth* — Advice to Mothers and Nurses, fyc. 
Page 5. 

The Chevalier Ruspini attributes caries to several causes : 

44 Various are the species of caries ; almost every part of the 
leeth is affected by it, and both internal and external causes 
produce it. 

44 The caries that proceeds from internal causes, namely, 



79 



Diseases of the Teeth. 



the scurvy, &c. generally affects the roots of the teeth, often 
the internal surface ; sometimes the external, and even the 
inward cavity of the body."-— Treatise on the Teeth, by Barth. 
Muspini. Page 55. London. 

Most of the above quotations, except that from Mr. Hunter, 
(whose mighty genius did not permit him to think the teeth 
beneath his notice, nor to neglect to set us an example, in 
this respect, worthy of imitation by the medical fraternity ; 
but which has been sadly neglected by it,) are from the pens 
of very eminent surgeon dentists ; men of finished education 
and scientific acquirements : we might carry them much far- 
ther ; but these are enough to show, that the opinions as to 
causes of caries are various ; and that many of these opinions 
have been hazarded, without a proper consideration of the phy- 
siology and pathology of the teeth, the only sure guides to the 
aetiology* of any disease. 

It is indeed surprising, that such opposite opinions should be 
eniertained by scientific men, as to the causes of a disease, 
which appears to us to be as easy of demonstration, as any 
problem in Euclid. 

If the vascularity of the teeth be admitted, of the certainty 
of which, we believe no one can doubt, after what has been 
said on the subject, the problem is at once soiled. 

First — The theory of the origin of internal caries, advanced 
by Mr. Fox, (namely, inflammation of the bony structure of 
the teeth,) as modified by Thomas Bell, satisfactorily ac- 
counts for all the phenomena of internal caries. 

S condly — The theory of the causes of external caries, (the 
chemical action of foreign matter and corrosive menstrua,) 
also, first advanced by Mr. Fox, afterwards embraced, as the 
exclusive cause of both species of decay, by Mr. L. S. Parmly, 
satisfactorily explains the phenomena of external caries. 

In order to establish these positions, it will be necessary to 



* Etiology. The causes of disease, the doctrine of the causes of 
disease. 



Diseases of the Teeth 7B 

examine the pathology of the teeth, and the aetiology and phe- 
nomena of caries. 

First — Is the peculiar structure of the teeth susceptible of 
inflammation ? 

Second— If it is, what will be the probable result of that in- 
flammation ? 

The two following laws in pathology (see Hunter on the 
blood) most admirably illustrate the origin of internal caries, 
by showing that the teeth are liable to inflammation,* and that 
this inflammation will be extremely apt to terminate in morti- 
fication, on account of the low degree of vitality, which they 
possess. 

First law — Those parts of the human body, which are the 
most vascular, and possess the greatest degree of vitality, are 
the most susceptible of inflammation, and when attacked by 
inflammation bear it best. 

Secojid law — Those parts which are the least vascular, and 
possess the least vitality, are the least susceptible of inflamma- 
tion, but when attacked by it, bear it worst. 

That the teeth are liable to inflammation, is made probable 
by comparing the symptoms of inflammation in the other 
bones, with those which many persons experience in their 
teeth, previously to the appearance of internal caries. — See 
Fox Natural History of the Teeth, part II, vage 13 ; Thomas 
Bell on the Teeth, jjage 124 ; and others. 

Do the phenomena of internal caries, bear out this conclu- 
sion ?f 



* " Every part of an animal body, the cuticle and hair excepted, is 
subject to inflammation ; and according to its structure, is inflammation 
occurring in ir, modified both in symptoms and termination."— Gre- 
gorys Elements of the theory and practice of Physic. Vol. I. p. 280. 

t " A tooth which has been the subject of inflammation, will remain 
•without any diseased appearance, for weeks or months afterwards; but 
at length the consequences which I have described become obvious, by 
the occurrence of a darkened spot which shows itself through the ena- 
mel ; and the gradual destruction of the tooth follows, if means he not 
taken to arrest its progress. I have known a case in which inflamma- 
tion had takan place through all the molar e? of one side ; both above 
and below ; and notwithstanding it was speedily subdued by leeches 
4 



74 Diseases of the Teeth, 

In the artificial exfoliation of internal caries, very often, the 
dead parts are peeled out, and we come to the sound bone at 
once. This is the white species of decay, of some authors, 
and is the animal matter of the diseased part of the tooth ; the 
lime having been dissolved or absorbed. This species is never 
seen in external caries, unless a large portion of the bone of 
the tooth has been destroyed by inflammation. 



&c. yet within a year afterwards, scarcely any of the teeth so affected 
had escaped the attacks of gangrene, although the corresponding teeth 
on the other side remained free from diseaes." — Thomas J3 ell, page 180. 

The case mentioned by Mr. Bell is not an isolated fact. We could cite 
a great number of similar cases if it were necessary.- We beg to mention 
the following case, which we think admirably illustrates the origin of 
internal caries. 

In the month of August 1834, a gentleman called on me for professional 
aid, stating that his teeth were rapidly decaying, and feared that he 
should lose many' of them in a short time. On examining his mouth, I 
found his jaws remarkably well developed ; the incisor es, cuspidati 
and bicuspides of the upper jaw, stood a little asunder, and without any 
symptoms of decay. The same teeth also of the lower jaw, were free 
from disease. But ten molar teeth were decaying, and the disease made 
its appearance in the centre of their crowns. In seven of these, the bonjp 
abcess had burst externally, so as readily to admit a large probe — in the 
other three, the enamel apparently was perfect, and the progressing 
disease was only indicated by its color underneath the enamel. 

In the artificial exfoliation of these teeth, I found the caries of that pe- 
culiar color, which always indicates great rapidity of destruction. In 
several of them, a large portion of the bony structure was destroyed, and 
I peeled out the disease, portion after portion, till I came to the sound 
bone, which was as defined, as the line of demarkation in a sphacelated 
limb. 

My patient was about 25 years of age — of a robust constitution; and 
one year out from England. He said that in the early part of the pre- 
vious winter, he had had ague in the face or swelled face, after exposure 
to cold and wet, and that last spring, he first discovered his teeth to be 
decaying. 

In the above case, it is evident from the great rapidity of the disease, 
its .peculiar color, and its defined boundary, that it must have been the 
result of inflammation and gangrene of a larere portion of the crowns of 
these teeth. If the teeth be always destroyed by external caries, caused 
by the chemical action of foreign matter, &c, the peculiar species of 
caries just mentioned, could never take place, nor could caries ever 
originate internally, the enamel being perfect. That caries frequently 
originates internally, is affirmed by the best writers upon the teeth, and 
is even admitted by those who contend that caries is always caused by 
chemical agents: but the latter assert, that there is a crack in the ena- 
mel, permeable to their causes of decay, which is readily seen by the aid 
of a magnifier, though not perceptible to the naked eye. This fanciful 
notioia requires no comment. 



Diseases of the Teeth, 75 

The teeih of all persons are liable to be attacked by internal 
caries, even of those, who have taken the utmost care to keep 
them free of foreign matter from childhood. 

The symptoms of internal and external caries, show that 
their causes are different, as will hereafter be described. The 
first appearance of internal caries in teeth, that have been kept 
free of foreign matter, is marked by a peculiar bluish or 
dark spot, shining or appearing through the transparent ena- 
mel, the integrity of which appears perfect; while the first ap- 
pearance of external caries is on the outside of the teeth, the 
enamel being first eroded or dissolved by the chemical action of 
foreign matter and the other agents to which they are exposed; 
External caries, also occurs in different parts of the teeth, from 
those of internal caries, and never attacks teeth that are kept 
free of chemical agents and stand a little asunder. 

The effects of climate, great and sudden changes of tempera- 
ture, hereditary- predisposition of the teeth to decay, or mal- 
formation of their structure, inducing decay, most conclu- 
sively prove, that the proximate cause of internal caries 
is inflammation of the bony structure of the teeth, as it is cer- 
tain that none of them could otherwise occasion caries. The 
advocates for the doctrine, that caries always originates external- 
ly, or on the surface of the teeth, must deny that the foregoing 
have any effect upon the teeth, or their arguments fall to the 
ground. We trust, that in the consideration of the particular 
causes of caries, it will appear beyond a doubt, that all these 
are prolific sources of caries of the teeth. 

The denies sapientitf are very liable to decay ; frequently 
before they have completely pierced the gum, caries will ap- 
pear in the centre of their crowns. 

The teeth of young persons, are far more liable to decay, 
than those of old persons ; and when attacked by caries, are 
destroyed in far less time ; because, as we advance in life, the 
vascularity of the teeth diminishes, and their structure becomes 
more dense from the gradual absorption of the animal matter, 
which enters so largely into their composition, and consequent- 
ly they are less susceptible of inflammation ; and also in the 



7B Diseases of the Teeth* 

ratio of our age, is our irritability and the susceptibility of &Uf 
our systems to inflammation and febrile excitement dimin- 
ished. 

Mr. Bell denies that foreign matter, or any thing that col- 
lects about the teeth, or is generated in the mouth, can be a 
cause of caries otherwise than as an inflammatory agent : that 
these cannot act chemically on the enamel of the teeth, as they 
have a less affinity for lime, than phosphoric acid has. But 
these assertions are certainly contrary to facts and observa- 
tion : all foreign matter, aided by the action of the saliva, 
particularly if it be vitiated, will gradually erode and decom- 
pose the enamel, and cause the bone of the teeth to decay ; 
this is proved by the following facts : 

The enamel next to the gum, if it has been covered with 
tartar for a length of time, is always found discolored, rough 
and decomposing. 

Persons who neglect their teeth, and allow 7 large quantities 
of tartar to collect about them, and the particles of food 
which lodge in theirdrrterstices during meal time to remain 
and undergo decomposition, are much more liable to have 
them decay, or their contiguous and lateral surfaces, than 
those who keep them free of these agents. 

It does indeed seem surprising, prima facie, that such should 
be the case ; but w T hen we consider that solvent power of the 
gastric juice — that it will decompose the hardest bone submit- 
ted to its action, and that the saliva is analogous in its compo^ 
sition-— that the hardest animal substances, of which artificial 
teeth are made, will be rapidly decomposed in the mouth — 
that most metallic substances are rapidily oxidized, when ex- 
posed to the action of the saliva — that plates of silver and gold, 
to which artificial teeth are attached, the latter not acted upon 
by nitric acid, soon become black or tarnished in the mouth, 
and that leaves of these metals, when triturated with saliva, 
soon become oxidized, although they are so difficult of oxida- 
tion ; our surprise vanishes, and we are compelled to yield to 
the abundant testimony of almost every observer. 



Diseases of the Teeth, 77 

The fact also, that vegetable acids act upon the teeth not- 
withstanding they have lesser affinity for lime, than the acid 
has, which enters so largely into their composition, as will 
hereafter be mentioned, strengthens this opinion. 

From these data, it is contended by Mr. L. S. Parmly, Mr. 
E. Parmly and some others, that caries of the teeth is always 
produced by external agents, or the action of foreign matter, 
corrosive menstrua and putrefactive agents : that hereditary 
predisposition, climate, the diseases of the general system, and 
all the causes of internal caries, hereafter to be treated of, can- 
not have any effect in producing caries, till the bone of the 
teeth is exposed, by the erosion of the enamel. We shall not 
dwell upon this doctrine, as we believe it to be wholly repug- 
nant to the physiology and pathology of the teeth. It may be 
proper, however to mention, that in proof of this theory, they 
advance the following arguments : — 

The teeth of persons who neglect them, are much more lia- 
ble to decay, than the teeth of those who keep them free of 
foreign matter. This is certainly true, and shows the great 
importance of keeping the teeth clean ; but the fact, we ap- 
prehend, has not the least weight in favor of their assertions; 
inasmuch, as the keeping of the teeth free of chemical agents, 
does not protect them from internal caries, and as external 
caries generally attacks different parts of the teeth, from inter- 
nal caries. 

The teeth of savages, they also say, are not so liable to de- 
cay as our own, because foreign matter does not collect about 
them; but surely, their teeth might be affected by the putre- 
factive fermentation of food, lodged in the interstices of teeth 
that are never cleaned. The fact is, the Indian is the simple 
man. His mode of life exempts his iron constitution, in a 
great measure, from that febrile state of the system or inflam- 
matory diathesis, so productive of disease in civilized life. It 
is a common observation, that the teeth of our forefathers were 
better than ours, though the dental art was almost unknown in 
their days. 



78 Diseases of the Teeth. 

The teeth of the lower jaw, they further say, are not so 
liable to decay as the teeth of the upper jaw, because the saliva 
gravitates and dissolves away the tartar and foreign matter 
from the former. This, however, is totally incorrect ; for the 
molares of both jaws are equally liable to decay, and the 
incisores of the lower jaw very seldom decay, though they are 
more frequently incrusted with tartar, than any other teeth in 
the mouth, on account of their proximity to the sublingual 
ducts, and of their situation being more favoroble to the depo- 
sition of this substance, suspended in the saliva ; while the 
incisores of the upper jaw, are particularly prone to disease. 
We think a more probable and the true reason, why the incisores 
of the lower jaw do not decay, is, that they are very small, of 
a more dense structure, and protected by a thick coat of ena- 
mel. Indeed, the enamel composes the greater share of their 
crowns. We have said more on this subject than we intend- 
ed; but we wish to advocate sound doctrine, as we have no 
dogma to govern us, and to show that the judicious practice of 
dental surgery, must be foanded on correct principles. 

The transplanting* of teeth from one mouth to another, as 

* " TRANSPLANTING THE TEETH.' 3 

We have often been asked the question by patients if it were possible 
to transplant a tooth from the month of one person to that of another. 
As a matter of curiosity, rather than utility, we beg to say a few words 
on this subject. The great Physiologist and Pathologist, Mr. Hunter 
among his thousand experiments on the living body, inserted the living 
human tooth into the combs of cocks, and found that adhesion took place, 
and in one instance, that there was a vascular connexion between the 
vessels of the pulp of the teeth and those of the comb. From these cir- 
cumstances, and others which he observed in the adhesion of teeth that 
had been forced out of their sockets by accident, he proceeded to trans- 
plant either living or dead teeth, first extracting the root of the decayed 
tooth and then slipping into its socket, the new one, and securing it with 
ligatures. This was a favorite theory with Mr. Hunter, and he recom- 
mended its practice to dentists, which is not a little surprising, pince he 
made so many discoveries, and understood the laws which govern the 
animal economy so perfectly. The incisores, cuspidati and biciispicles 
only could thus be transplanted, the diverging fangs of the molares pro- 
hibiting the practice with them. 

Transplanting the teeth was pursued till the occurrence of several 



Diseases of the Teeth, 79 

recommended by the great John Hunter, was productive of 
much mischief. 

The theory and practice* of the late Mr. Fay, of snapping 
off the crowns of aching teeth, with his cutting forceps, and 
thereby preserving a bony surface for mastication, has been 
entirely exploded, though it was once countenanced by eminent 
medical men, as Sir A. Cooper. 

As we believe enough has been said to show, that the causes 
of internal and external caries are different, we shall proceed 
to analyze these causes. 

The causes of caries of the teeth may be divided into, 

1st — Predisposing, 

2nd — Exciting. 

3rd — Proximate. 



cases of disease, proving fatal in one or two instances, transplanted with 
the teeth, damned it forever. 

Throwing aside the moral turpitude of disfiguring one person, for the 
purpose of beautifying another, and the dagger of innoculatmg disease, 
(for none but the most abject and degraded would thus suffer mutilation 
for money,) such teeth could never prove of much utility; for the vascu- 
lar and vital connexion existing between the sockets and the teeth being 
destroyed, -they would become foreign bodies, and be apt to be produc- 
tive of much mischief. Hence the impropriety and failure of Mr. Fox's 
plan of curing aching teeth by dislocation or partial extraction. 

* « EXCISION OF THE TEETH. 3 ' 

Whenever the teeth are extracted, their sockets are absorbed, and so 
great is the absorption, that the loss of the teeth shortens the face an 
inch and a half. Mr. Fay supposed that the absorption might be pre- 
vented by the excision of the crowns of aching teeth, instead of extracting 
them, leaving the fangs in their sockets thereby preserving a bony sur- 
face highly useful for mastication. For this purpose he constructed a 
pair of cutting forcips, with which he could snap off the crown of an 
aching tooth just below the nerve, with very little pain to the patient. 
Having obtained some converts to his theory, and some eminent medical 
men to recommend its practice, he proceeded some years ago to put it to 
the test of experience, and commenced his operations in London, where 
the novelty of the practice attracted considerable attention, in conse- 
quence of which, he began to reap a " golden harvest; 5 ' when, unfor- 
tunately for him, but happily for the community in which he lived, it 
was destroyed by a tempest, for the operation was irrational, often un- 
successful in its immediate effects, and pernicious in its consequences, 
as will be seen under the head of " effects of dead teeth, roots, &c." It, 
like all false theory, was doomed to ephemeral fame, and is now entirely 
abandoned and forgrotten. 



80 Diseases of the Teeth. 

These divisions we think more apropos, as applied to the 
diseases of the teeth* than to the diseases of the general sys- 
tem. 

The predisposing causes of caries, are defective organiza- 
tion of the teeth, arising from hereditary affections, or the ac- 
tion of disease during their formation, and certain states of the 
system. 

The exciting causes are climate, great and sudden changes 
of temperature, and all the general causes of inflammation ; 
diet, a febrile state of the system, as in dyspeptic affections, 
pregnancy, &c. ; certain medicines, as mercury; chemical 
and mechanical agents. 

The proximate cause, is inflammation of the bony structure 
pf the teeth, in both species of decay. 

PREDISPOSING CAUSE OP CARIES. 

H Hereditary predisposition is among the most common and 
remarkable of the former class. It often happens that this 
tendency exists in either the whole or a greater part of a fam- 
ily of children, where one of the parents had been similarly 
affected ; and this is true, to so great an extent, that I have very 
commonly seen the same tooth, and even the same part of the 
tooth, affected in several individuals of the family, and at about 
the same age. In other instances, where there are many 
children, among whom there exists a distinct division into two 
portions, some resembling the father, and others the mother, 
in features and constitution, I have observed the corresponding 
difference in both as it regards their form and texture, antl 
their tendency to decay." — Thomas Bell, page 128. 

The whole list of infantile diseases, and the profuse admin- 
istration of mercurial medicines, for their cure, operating 
during the formation of the permanent teeth, undoubtedly 
strongly predispose them to future decay, by producing de-. 
fective organization of their structure, as is well illustrated in 
\he following case : 



Diseases of the Teeth, SI 

My friend, Mr. has a little daughter, nine years of 

age, all of whose permanent teeth, viz. the four first molares 
and the ineisores of both jaws, are very remarkable for defect 
in their structure. They are of a dirty yellow color, and have 
crumbled away almost to the gum : she was remarkably puny 
till six or seven years old. 

A strumous constitution, is very often accompanied by early 
and general decay of the teeth. The following striking exam- 
ple is from Mr. Bell : 

" Miss II. a young lady, seventeen years of age, possessing 
that remarkable transparency of skin, and delicacy of fea- 
tures, which too often indicates incipient consumption, con- 
sulted me respeccting the state of her teeth. The enamel 
where it remained, was of that beautiful pearly whiteness and 
transparancy which characterize teeth of a weak and frail 
texture ; but there was not a single tooth, either in the upper 
or lower jaw. which was not to a greater or less degree the sub- 
ject of gangrene. Not one even of the inferior ineisores, so sel- 
dom attacked by disease, had escaped its ravages." — Page 129. 

That morbid affections of the constitution, occurring during 
the foimation of the teeth, produce in them a predisposition 
to decay, receives a strong confirmation from the fact, that in 
the greatest number of cases, they become diseased in pairs ; 
for the teeth would naturally participate in the changes which 
the constitution may suffer during the period of their forma- 
tion, and w r ould be more or less liable tp disease, in proportion 
to the injury thus inflicted on them. 

EXCITING CAUSE OF CARIES, 

These will be considered under the heads of internal and 
external caries. 

PROXIMATE CAUSE OF CARIES, 

The proximate cause of both interna] and external caries, is 



82 Diseases of the Teeth* 

inflammation of the bony structure of the crowns of the teeth, 
terminating in gangrene or death of such parts. 

" The proximate cause of caries, appears to be an inflamma- 
tion of the bone of the crowns of the teeth, which, on account 
of its peculiar structure, terminates in mortification." — Fox. 
Part II, page 12. 

" Caries, in fact, is that state of the tooth, in which mortifi- 
cation has taken place in one part, and inflammation in the 
part contiguous to it; the former, originally produced by the 
latter, and the latter kept up by a continued contact with the 
former." — Kocchefs Dental Surgery, page 211. 

44 When a portion of any of the other bones loses its vitality, it 
acts as an extraneous body, producing irritation in the sur- 
rounding parts, and a process of absorption is set up in aline of 
living bone in contact with it, in order to effect its separation. 
A similar effort appears to me to be made in a gangrene 
of the teeth, but with a very different result, in accordance 
with the difference of the structure of the two seats of the dis- 
ease. When a portion of a tooth is killed by inflammation, it 
excites, as in the other case, an increased action in the vessels 
of the surrounding portion of bone ; but that very action, 
which, in such bones as possess greater vital power, becomes 
remedial by promoting the removal of the cause of irritation, 
produced in the present case, the continued extension of the 
disease: for the irritation thus excited, instead of effecting the 
removal of the part by absorption, as in other necrosed bones, 
at once destroys its vitality, and renders it only an additional 
portion of dead matter to that which had already existed. 
This, in its turn, becomes an extraneous and irritating body to 
the surrounding bone, in which the same action is set up, and 
the same mortification produced, and thus portion after portion 
is successively irritated and killed, until the whole crown of 
the tooth is destroyed." — Thomas Bell on the Teeth, page 126, 

Our opinions with respect to the causes of the continued ex- 
tension of caries differ somewhat from those expressed in the 
above quotations. After the disease has attacked a tooth, its 



Diseases of the Teeth. S3 

action is kept up, not so much by being in contact with the 
dead portions of bone, as with the various irritants and chemi- 
cal agents to which it is exposed. 

INTERNAL CARIES. 

Origin, always in the internal bony structure of the teeth. 

Symptoms — The first appearance of this species of caries, 
w r ill be marked for the most part, by a dark bluish spot, 
appearing or shining through the transparent enamel, the 
integrity of which, at this stage of the disease, appears perfect. 
This spot is usually found in the centre or irregularities of the 
crowns of the molares, and on their side midway between the 
gum and their grinding surfaces. In the hicuspides, it appears 
on the grinding surfaces, and in the incisores of the upper jaw, 
the spot is seen on the inner surface, near the gum. In this 
stage of the disease, if the tooth be sawn through, a dark 
brown streak will be seen extending deep towards the internal 
cavity, and in the direction, we may suppose the vascular and 
nervous fibres run. As the disease progresses, these appear- 
ances are more strongly marked, till at length, the enamel 
being undermined, gives way while masticating some hard 
substance, and exposes a cavity more or less extensive. The 
disease now progresses more rapidly, from the action of mat- 
ter admitted into the cavity, till the internal membrane is ex- 
posed and irriated, and tooth ache follows. 

When internal caries has attacked a tooth, its progress wilt 
be governed in a measure, by its structure, or its predisposi- 
tion to decay, sometimes extending to the nerve in a few 
months, and at other times, being the work of years. 

EXCITING CAUSES OF INTERNAL CARIES. 

Climate — The teeth are said to decay much earlier and 
more frequently in America than in Europe. The great and 
sudden changes of temprature to which our climate is subject, 
is one principal reason that is to be assigned, to account for 
these facts. 



84 Diseases of tlu Tketh. 

That climate has a great effect, in inducing caries of the 
teeth, is made probable by the following circumstances : 

First — Europeans have better teeth than Americans. 

Second — The teeth of Europeans who have resided in this 
country for a few years, are as subject to decay as our own. 
We have often heard patients declare, that their teeth were 
not in the least decayed, till they came to America, and en- 
quire the reasons why they are so much more subject to decay 
in this country, than in England. That the teeth are very 
liable to decay in this country, is known and dreaded by every 
foreigner, who takes up his above among us. 

Third— A. very powerful circumstance, showing the effect 
of climate, and the origin of internal caries to be inflammation 
is the following : 

Negroes are said to have much better teeth than white peo- 
ple, which Dr. Fitch ingeniously attributes to the peculiar 
conformation and rotundity of their jaws, which are very fa- 
vorable to the perfect developement of the teeth. There are 
a few residing at Montreal, and it is remarkable, that they 
have much w T orse teeth than the Canadians. Of the truth of 
this, abundant observation has convinced us ; several, not 
thirty years of age, are almost edentiless. 

The Canadian habitant is hardy, frugal, and accustomed to 
his climate. He w T ill sally out of his snug dwelling, which 
he keeps at a temperature of seventy-five or eighty degrees of 
Fahrenheit, into an atmosphere of twenty or twenty-five be- 
low zero, with comparative impunity ; while the piercing 
frost, chills the very vitals of the negro, bred in a warmer and 
more congenial clime. If climate has such an effect in induc- 
ing caries of teeth, we ask, throwing all other arguments 
aside, if it is not a conclusive proof, that the teeth are suscep- 
tible of inflammation, and that inflammation must be the 
proximate cause of caries ? If caries be always produced by 
external or chemical agents, it is evident that the teeth should 
not be more liable to decay in one country, than in another. 



Diseases of the Teeth. 85 

HEAT AND COLD.* 

We may suppose, that very hot or cold drinks, and hot food, 
as well as great and sudden changes of temperature in climate, 



* "Probably some internal action is continually taking place in the 
teeth, though we are not able to trace it very evidently. The chief causes 
of caries are undoubtedly external, but it may be sometimes produced 
by an internal cause. We have already noticed exposure to currents of 
cold air, and the medical practitioners of Germany and the north appeal 
to the opposite extreme of the habitual use ot hot aliments, as a still 
more general and mischievous source of the same evil, in the Swedish 
Amcenitatcs Academicce, we have an elaborate examination of this sub- 
ject by M. Ribe, who tells us, among other things, ■ that man is the 
only animal accustomed to hot foods, and almost the only animal affect- 
ed with carious teeth, 5 Whence the author takes occasion to condemn, 
in an especial manner, the custom of drinking hot tea and coffee ; and, 
in accordance with this remark and recommendation, M. Tillcsus, another 
celebrated writer in the same interesting journal, tells us from Kalm, 
in his paper entitled Potus Thece, that the Indians of North America 
knew nothing of inconvenience of carious teeth or debilitated stomachs, 
till tea was introduced among them. [Though the Swedes are celebra- 
ted for their depth of research, in all scientific subjects, the above obser- 
vations are bathos.] There can be no question that the two extremes of 
heat and cold must be greatly, perhaps equally injurious to their health ; 
and as little, that the inhabitants of high nothern latitudes must suffer 
more than others from the use of hot aliments, in consequence of the 
greater coldness of their atmospherical temperature. 

11 To the abuse of hot beverages as a cause of caries, M. de la Salle adds 
the abuse or excessive employment of sugar ; and seems to imagine that 
these are the two principal means by which teeth are rendered black in 
their enamel, and carious in their substance." — Good's Study of Medi- 
cine, vol. II, page 47. 

It is a general opinion that sugar and all kinds of sweet things are 
highly productive of decay, and this opinion appears to be founded on 
the circumstance that they often occasion painful sensations in the teeth, 
when taken into the mouth. 

Sugar cannot act directly on the teeth, for, though it contains the prin- 
ciple of acidity, its affinity for lime bears but a small proportion to that 
of phosphoric acid, of which the enamel is principally composed. By fer- 
mentation, it gives forth the acetous acid ; by distilation with nutric 
arid, it forms oxalic acid, which has a stronger affinity for lime than 
other acid whatever. Without one of these combinations, the action of 
sugar upon the phosphate of lime must be extremely weak, for the min- 
eral acids, the oxalic, tartaric and succinic, are the only known acicrs, 
whose affinity for lime, is stronger than that of phosphoric acid. We have 
kept teeth in sugar and syrup for upwards of four months^ and yet they 
have not undergone any apparent change. The Duke of Beaufort is said 
to have eafen a pound of sugar every day for forty years, and lived to 
the age of seventy. After death, his teeth were found to be perfectly 
sound. 



86 Diseases of the Teeth. 

are productive of internal caries, by inducing immediate in- 
flammation of the bony structure of the teeth. No part of the 
system is so much exposed to the changes of temperature 
as the teeth, and the low degree of vitality which they possess, 
ill fits them to bear its extremes. Whenever we take any 
thing hot or cold into the mouth, we experience a painful sen- 
sation, which would seem a monitor that such extremes are in- 
jurious. Mr. Fox supposes, that this is a reason why savages 
and people of tropical regions, have better teeth than the in- 
habitants of cold or temperate climates. This is undoubtedly, 
one reason, but a greater, we think, is the habits of the sa- 
vage, and the climate of tropical regions, which are not subject 
to the great and sudden changes of cold regions. 

DIET. 

Different kinds of food, can only be productive of caries, as 
of diseases of the general system, by inducing an inflam- 
matory diathesis, deranging the digestive organs, or by being 
of too high or low a temperature. As luxury, indolence and 
ease, are condusive to diseases of the general system, so are 
they equally condusive to those of the teeth. Hence savages, iri 
their native forests have good teeth, while those who live neaf 
their white brethren and participate in their luxuries and vices, 
are subject to their diseases, and among them, to the diseases of 
the teeth. Hence also, our forefathers had better constitutions, 
and fewer diseases than we have. 



The negroes in the West Indies are said to have very sound teeth, 
though it may be supposed, they eat much sugar. 

The use of too much sugar may be productive of caries indirectly, by, 
deranging the digestive organs. 

Tobacco. — The use of this plant is considered by some authors, and by 
many persons, very obnoxious to the teeth. We do net think it at all 
productive of decay, if used in moderation, but rather preventive than 
otherwise, as it is a most powerful sedative, and tends to allay irritation. 
It possesses no principle, that can act chemically on the teeth, though its 
constant use generally discolors them, or gives them a yellowish cast. If 
its use be carried to such an extent as to derange the digestive apparatus, 
i> will probably prove injurious to the teeth, as well as the general 
evstem. 



Diseases of the Teeth, 87 



A FEBRILE STATE OE THE SYSTEM. 

A febrile state of the system, is a prolific cause of caries; 
Very often after severe attacks of illness, the patient will per- 
ceive that holes are coming in teeth which he previously 
thought perfectly sound, and that they are rapidly decaying. 
This he ascribes to the effects of powerful medicines adminis- 
tered to him. We have seen many cases in confirmation of 
this fact. 

Persons laboring under dyspeptic affections, often have bad 
teeth. It is a well known fact, that during pregnancy, the 
teeth of women are much more liable to decay, and decay fas- 
ter, than at other times. 

There are many exceptions to all these, which circumstance 
has induced some to reject them altogether, but the man of 
observation will perceive facts enough to convince him of their 
truth, as a general rule. 

MERCURY. 

The profuse administration of mercury, is recorded by most 
dental authors, as a grand cause of caries. It probably con- 
duces to internal caries, by inducing inflammotory action in 
the bony structure of the teeth, or by making them more sus- 
ceptible of inflammation. In external caries, in addition to 
the above, it will vitiate the saliva. That the above opinions 
are correct, is made probable by the fact, that those persons to 
whom mercurial medicines have been freely and frequently 
administered, have generally wretched mouths. 

EXTERNAL CARIES. 

Symptoms — This species of decay is most apt to attack the 
teeth of persons having a sickly constitution, or derange- 
ment of the digestive organs ; also, the teeth of those who neglect 
them, the disease making its appearance on their Opposing 
surfaces, or on their external surfaces near the gum, 



88 Diseases of the Teeth, 

where the enamel is thinest, and tartar and other matter most 
liable to collect. 

There is no difficulty in distinguishing external caries : on 
the sides of the teeth, a depression or hole more or less exten- 
sive will be seen, of a greenish or brown color : when the 
disease has attacked the molares or bicuspides, on their conti- 
guous sides, it will be indicated by a dark or bluish color* ap- 
pearing through the enamel, between them. In the incisores, 
it is at once seen* and cannot be mistaken. 

The predisposing causes of external caries, are the same as 
those of the first species, or of internal decay. To these may 
be added, defective enamel, presenting what is called the 
honey-comb appearance : such teeth are sometimes cf a yel- 
lowish color, and of a brittle texture, and are strongly pre- 
disposed to decay. 

The exciting causes, are chemical and mehanical agents. 

TARTAR OF THE TEETH OK SALIVARY CALCULI. 

This substance, which is secreted with the saliva, often col- 
lects about the teeth in great quantities ; particularly, about 
those near the entrance of the salivary ducts. When it is first 
secreted, it is quite soft like slime* and may be easily removed 
with a tooth-brush and dentrifice ; but if neglected, it soon be- 
comes concrete and hard; Tartar of the teeth is a common 
cause of external caries, by acting chemically on the enamel, 
and exposing the bone of the teeth, to the action of foreign 
matter, and to inflammation. It discolors, erodes, and de^ 
composes the enamel, as is always seen with teeth, that have 
been covered with it for a length of time. In this case, the 
teeth next the gums are found rough, and of a yellow color, 
and frequently, the enamel is completely destroyed across 
their necks. 

PUTREFACTIVE AGENTS. 

By putrefactive agents are meant, the particles of food lodg- 
ed in the interstices of the teeth, which if not removed, undergo 



Diseases of the Teeth. 89 

decomposition, and aided by other agents, have a very perni- 
cious influence. Tartar and putrefactive agents are the grand 
causes of caries, and of all the diseases of the gums and sock- 
ets. The tartar gradually separates the gum from the necks 
of the teeth, by insinuating itself deeply between them, and 
aided by other causes, produces inflammation of the gums, 
which gradually become of a livid color, sore and spongy, and 
bleed on the slightest touch ; the disease extends to the sock- 
ets, constituting what is vulgarly called, scurvy in the gum. 
A puriform discharge takes place around the necks of the 
teeth — the periosteum and the alveoli are gradually absorbed 
— the teeth become loose, and deposition of bony matter at the 
bottom of the sockets, gradually protrudes the teeth, and gives 
them a hideous appearance, and soon they drop out, one after 
another, perfectly sound, wholly the effect, of neglect! This 
is usually the work of some years: the incisores of the lower 
jaw, are generally lost by scurvy in the gum; for these teeth 
very seldom decay, for reasons before mentioned. That tartar 
and putrefactive agents are the general causes of external 
canes, and frequently of the diseases of the gums and sockets, 
is proved by the fact, that the teeth of those persons who have 
always kept them free of these agents, are seldom attacked by 
external caries, if they have been well formed and developed 5 
and that diseases of the gum and sockets are unknown to such 
persons, unless brought on by disease of the general system, 
or the administration of mercurial medicines. 

A VITIATED STATE OP THE SALIVA* 

That the saliva may, and does become vitiated, we think is 
proved by the circumstance, that artificial teeth decompose 



* ACIDS IN THE SALIVA. 

In persons of a weakly constitution, or in those having a febrile state 
of the system, or derangement of the digestive organs, the secretions of 
the mouth, often become deteriorated as well as those of the body. The 
saliva often becomes remarkably active under such circumstances, as is 

4* 



90 Diseases of the Teeth. 

much sooner in some months than in others, and that this 
happens in persons of a weakly constitution, or of a febrile 
system, or who neglect to keep their teeth free of foreign mat- 
ter. That a vitiated state of the saliva, assisted by other 
causes, may be, and is a principal cause of external caries, we 
apprehend cannot be doubted, from what has been said on the 
chemical action of the causes of external decay. (See page 76.) 
The saliva will probably be vitiated by these circumstances. 
In healthy persons, by neglect, tartar and putrefactive agents, 
decaying teeth and dead stumps, and decomposing artificial 
teeth, all indicated by an offensive breath. In sickly persons, 
to the above may be added a febrile state of the system, 
derangement of the digestive organs, mercurial and other 
medicines. 

CHEMICAL AGENTS. 

Though all the exciting causes of external caries, except 
the mechanical, act chemically on the teeth ; this term may 
be properly applied to the mineral acids and some of their 
salts. 



seen from its effects on the teeth especially on artificial teeth which are 
sometimes decomposed with wonderful rapidity. The cause of this acid 
quality of the saliva is probably muriatic acid : this is the more probable 
as the muriatic acid is the principal active agent in the gastric juice, 
with which the saliva is somewhat analogous in composition. We have 
often tested the saliva of persons under the circumstances we are treat- 
ing of, with a solution of the nitrate of silver, but not with satisfactory 
results, though we think we have occasionally perceived very slight in- 
dications of muriatic acid. Persons who value their teeth, under such 
circumstances should take great care of them. The frequent rincing of 
the mouth with an alkaline solution would probably prove of advantage, 
as it is evident that some acid is generated, which the alkali will neu- 
tralize. 

In healthy persons who neglect the mouth, and allow the food lodged 
between the teeth to undergo decomposition, an acid also is generated ; 
for the enamel which is principally composed of phosphoric acid and 
lime, could not discolor and decompose, unless an acid having a 
powerful affinity for lime be present ; and this acid is the acetic. A 
variety of combinations take place under such circumstances, water and 
ammonia are probably generated, also carbonic acid, phosphuretted and 
sulphuretted hydrogen gasses, as are indicated by the offensive breath. 



Dis&ease of the Teeth 91 



MINERAL ACIDS.* 

Whole sets of teeth are frequently ruined, by the careless 
and culpable manner of administering these medicines. 

VEGETABLE ACIDS. 

It has been said, that vegetable acids cannot act on the teeth, 
on account of their having a lesser affinity for lime, than 
phosphoric acid has. But here quantity predominates over 
affinity,! as any one may satisfy himself, by puttiug a tooth 
into almost any vegetable acid, when it will be gradually de- 
composed. Vinegar usually contains more or less sulphuric 
acid, and therefore acts more energetically. Supertartrate of 
potash will decompose a tooth. However, we do not appre- 
hend, that the vegetable acids, as we use them for a whole- 



* The mineral acids or their preparations are frequently administered 
for the cure of disease, and though the physician cautions his patient of 
their pernicious effect upon his teeth, if means are jnot taken to pre- 
vent them from coming in contact with the teeth, yet it frequently hap- 
pens either from ignorance, carelessness or neglect. Such medicines 
should always be drawn through a quill or tube, into the back part of 
the mouth, that they may not touch the teeth and the mouth rinced im 
mediately after with an alkaline solution. The earbonate of soda will 
make a good one. 

t AFFINITY OR CHEMICAL ATTRATION. 

Affinity or chemical attraction is a power exerted between the particles 
of different kinds of matter, causing them to combine so as to form new 
bodies, possessing entirely new properties. 

"It frequently happens the formation of a new compound is attended by 
the destruction of an existing one. The only condition necessary for 
this effect, is the presence of some third body, which has a greater affinity 
for one of the elements of a compound than they have for each other. 
Thus oil has an affinity for the alkalis, as potassa and soda, and will 
unite with them, forming soap. But the alkalis have a still greater 
attraction for sulphuric acid ; and hence if this acid be added to a solu- 
tion of the soap, the alkali quits the oil, and unites with the acid. Sul- 
phuric aeid in like manner separates lime from muriatic acid. Thus 
ammonia will separate magnesia from sulphuric acid, lime ammonia 
and potash lime. Decomposition and combination occur in each of these 
instances. 

11 The influence of quantity of matter over affinity is universally ad- 
mitted." — Turner's Chemistry. 



§2 Diseases of the Teeth, 

some beverage, or articles of luxury, can, have any material 
influence upon the teeiiu 

QUACK NOSTRUMS, 

As " dentri frees and tooth pastes for whitening and preserv- 
ing the teeth, " do whiten them by decomposing the ena- 
mel, and are injurious. 

Lotions "for whitening the teeth, &e." Much of the fash- 
ionable lotion, sold under the name of the Chlorine Tooth 
Wash, is very injurious to the teeth, from the action of the 
muriatic acid, which enters so largely into its composition, and 
should never be used. We have seen lotions, sold with the 
highest recommendations as preservatives of the teeth, act so* 
powerfully as to destroy the enamel of a tooth immersed in it ? 
in two or three hours. 

MECHANICAL AGENTS. 

Bentrifices of too gritty or cutting a nature, or not suffi- 
ciently pluverized. However, little injury is done to the 
teeth, by this class, for most persons hardly keep their teeth 
free of tartar and foreign matter, and if they do not, it is cer- 
tain they cannot v/ear the enamel ; besides, it is of too hard a 
nature to be easily worn. It is a great fault with many per- 
sons, that they do not use a dentrifice as freely as they ought, 
if they use one at all, for fear of wearing out their teeth. 

Dead teeth and stumps, and decomposing artificial teeth. 
All these are highly injurious to the adjoining teeth, as is 
shown by the fact, that a tooth decaying on its side, is sure to 
effect the adjoining tooth, by the acrimonious matter generated 
in the decaying tooth. 

Lastly, of a crowded state of the teeth, and irregularities of 
the teeth. 

The incisores, cuspidati and bicuspides of the upper jaw, 
when crowded together, or irregular, for the want of early and 
proper dental assistance, are very liable to decay. Mr. Bell 



Diseases of the Teeth. 93 

supposes, that this is owing to the pressure of the illaleral sur- 
faces of the teeth against each other, causing inflammation^ 
and consequently gangrene of the bone of the teeth, imme- 
diately under the enamel. There may be something in this 
hypothesis, but we apprehend that a crowded or an irregular 
state of the teeth, is conducive to caries, by forming a nidus 
for the lodgement and retention of foreign matter, and thus 
favoring its chemical action on the enamel till the bone of the 
teeth is exposed and decays, This is the more probable, as 
such teeth when kept clean, are not so liable to decay as those 
that are neglected ; and as the enamel is first discolored on its 
external surface. 

In our opinion the cause of the effect, is the play of chemical 
affinities, as on inorganic matter, till the enamel is destroyed, 
when the progress of the disease will be governed by the laws 
of the animal economy. The decay of the incisores, enspidati 
and bicuspides, under the circumstances we are treating of, 
may be illustrated by the effect produced upon tw r o pieces of 
timber, placed in contact and exposed to the elements — they 
decay on their contiguous sides*, but place them a little asunder 
and they do not decay. 

TREATMENT OF INTERNAL AND EXTERNAL CARIES. 

The curative treatment of caries, is artificial exfoliation, or 
the perfect exterpation of the disease, with instruments, and 
plugging the cavity with gold. 

Prognosis. In the first stage of the disease, or before the 
internal membrane is exposed, the cure is certain. See the 
subject "of plugging the teeth." 

ODONTITIS. 

Inflammation of the internal membrane. It may terminate 
in resolution or suppuration. Odontitis is usually caused by 
the exposure of the internal membrane, from caries, to vari 
pus kinds of irritating matter. It also sometimes happens 



94 Diseases of the Teeth. 

spontaneously, in a perfectly sound tooth, and occasionally 
terminates in suppuration, forming the disease termed by Mr. 
Fox, spina ventosa of the teeth. 

Treatment — The various applications in common use, at 
best are only palliating ; therefore, it is best either to extract 
the tooth at once," or attempt to save it by destroying the inter- 
nal membrane and plugging the tooth. If the tooth be sound, 
and the internal membrane proceed to suppuration, it should 
be trephined, or a hole drilled into its cavity, so as to evacuate 
the matter ; and when the tooth has got well, the hole should 
be plugged. 

PERIOSTITIS. 

Periostitis is an inflammation of the periosteum of a tooth, 
and when there are dead teeth or stumps in the mouth, is a 
common consequence of cold. It frequently proceeds to sup- 
puration, forming gum biles, which sometimes ulcerate through 
the cheek, producing ugly ulcers, which leave an unseemly 
cicatrix behind. 

Treatment — Removal of the cause, viz. the extraction of the 
dead teeth or fangs. 

EXOSTOSIS. 

This disease is an enlargement of the fangs of the teeth, 
from a deposition of ossific matter, as in other bones, and 
causes severe pain. 

Treatment — Extraction of such teeth. 

NECROSIS, 

Is the death of a tooth, caused by the destruction of the 
internal membrane, or disorganization of the periosteum. 
Treatment — Extraction, if the tooth cause much irritation. 

DENUDING PROCESS. 

This is a disease which occasions the loss of a portion of the 



T Diseases of the Teeth. 95 

enamel, and sometimes extends deeply into the bone of the 
teeth, as though it had been removed with a round file. It 
generally attacks the incisores, and sometimes extends in a 
straight line across the teeth, to the cuspidati, bicuspides, and 
even the molares. The teeth have a high polish, and are not 
discolored. The cause of this peculiar disease, has not been 
satisfactorily explained, though it is probably friction. 

ABRASION. 

This is a term applied by Mr. Thomas Bell to a curious 
process, by which the front teeth and bicuspides waste away, 
without any apparent cause. The disease sometimes attacks 
the incisores. 

Mr. Bell mentions only one case in which the front teeth 
were wasted nearly away to the gum — were highly polished, 
and could not by any means be brought into contact. Dr. W. 
Spooner, has seen an instance of this curious disease. It is di- 
fficult to assign any cause for it, unless it be chemical action. 

In conclusion, caries is the only disease of much importance, 
to which the teeth are subject, as their other diseases are, 
comparatively, of rare occurrence. We have before assert- 
ed, as the opinion of the scientific dentists of the present 
day, that most of the teeth may be preserved to the end of life. 
We beg to quote the following observations of Dr. Fitch, which 
are very much to the point. He says : — 

" It is an impression generally abroad in the minds of medi- 
cal men and philosophers, that the decay and loss of the teeth 
is a necessary consequence of advanced years, but I humbly 
conceive that no mistake is greater. The universality of the 
fact is not a positive proof, that it is a necessary consequence 
of age, for there are numerous instances of persons who have 
not attained the middle period of life, and yet have lost all 
their teeth. It only proves this, that those destructive agents 
which are the exciting causes of the disease in the teeth, gums 
and alveoli, are implacable and persevering foes to the health 



06 Diseases of the Teeth. 

of these parts, which if not as perseveringly opposed, baffled 
or removed, will pursue the health and vitality of the teeth 
until they have eradicated these useful and beautiful organs 
from the mouth. Had the all- wise Author of nature intended 
that the leeth of- man should be lost in his declining years, 
and this be a necessary consequence of age, it would always 
be the case, and an old man with teeth would be a lusus na- 
tures. But this is not the case ; a vast many aged persons go 
down to the grave possessing sound and beautiful teeth. It 
should be always remembered, that the teeth fail only in the 
same ratio as the other organs of the system, and that their 
local diseases are not the natural consequence of age, but of 
other causes ; and if prevented and preseveringly obviated, 
that it is in the power of every individual by early persever- 
ing, and judicious attention to his teeth, to preserve them to an 
advanced age." — Fitch on the Teeth. Page 427. 

The universality of caries of the teeth, and the frequency of 
the diseases of the gums and sockets, show that they are ex- 
tremely liable to disease, and the necessity of early attention, 
for preventive treatment. 

For proof of the doctrine that the teeth of most persons 
may be preserved to the end of life, see the prtventative and cura- 
tive treatment of the diseases of the teeth. 



[e^d of the inaugural dissertation.] 



PREVENTIVE AND CURATIVE 



TREATMENT OP THE 



DISEASES OF THE TEETH. 



CAN THE TEETH BE PRESERVED TO THE END OF LIFE 1 

In the introduction of this work, we have pledged ourselves 
to attempt to show that the teeth of most persons may be pre 
served to the end of life. We are fully aware, that in the 
opinion of many, this will be a difficult task ; indeed an in- 
surmountable one : notwithstanding, with a firm belief in the 
correctness o[ the views we are about to advance, we shall 
use our best endeavors to prove to the satisfaction of reasona- 
ble minds, that the teeth of all persons which are constitutionally 
well formed, or whose structure is good, ivho enjoy such health 
that the secretory organs be not destroyed, may be preserved 
to the last day of their existence. 

Some go even farther, and assert that the teeth of all per* 
sons may be preserved through, life. We do not believe this 
doctrine, for the teeth of some individuals are so defective in 
their organization, and the health of others is so bad, and the 
secretions of the mouth as well as the body so vitiated, that the 
5 



98 Preventive Treatment of Caries* 

teeth will decay in spite of art, though it may very much 
retard its progress. These cases, however are very rare. 

There are but two diseases fatal to the teeth, that require 
consideration, in order to show the correctness of our position; 
namely, caries, and disease of the gums and sockets, common- 
ly called scurvy in the gum, and it will be necessary to exam- 
ine these diseases, how far they may be prevented, and wheth- 
er they may be effectually cured when developed. The other 
diseases to which the teeth and gums are subject are compara- 
tively of rare occurrence, and hence of minor importance. 

The circumstances under which the teeth are most liable to 
decay, the effects of which can be obviated, are the following, 
and most clearly point out the means within our power to be 
used for the prevention of decay. 

First — The front teeth and small double teeth, when irregu^ 
lar or crowded together almost invariably decay : on the con- 
trary, when they stand a very little asunder they rarely decay, 
if kept clear of foreign matter. 

Second — Teeth that are neglected, tartar and other foreign 
matter allowed to collect about them, and the particles of food 
lodged in their interstices during meal time, to remain and de- 
compose, are more liable to decay, than those that are kept 
clean and free of these destructive agents. 

PREVENTIVE TREATMENT OF CARIES. 

The above facts indicate at once the preventive treatment of 
decay ; namely, so to manage the teeth during the second denti- 
tion, that their regularity, symmetry and beauty may always 
be ensured, and that they may stand a little asunder, or at 
least not be crowded together ; also, that the teeth be kept 
perfectly free of all foreign matter. 

The means necessary to be employed in order to obtain a 
regular set of teeth, have already been considered, under the 
head of irregularities of the teeth, (See page 39.) Those 
necessary to keep the teeth clean, will be pointed out in a 
future chapter. 



Preventive Treatment of Caries. 99 



OF A CROWDED STATE OF THE TEETH. 

A crowded state of the teeth, as well as irregularities, is 
also highly conducive to decay, and for the same reasons ; 
(see page 92,) though the latter are more liable to decay, on 
account of the great difficulty experienced in keeping such 
teeth free of foreign matter. 

It must appear obvious to all, especially to parents, who 
have such important duties to their offspring to discharge, that 
the management of the teeth of children for the prevention of 
future decay, is a subject of much importance to their wel- 
fare. We wish especially to draw public attention to this 
wholly neglected subject, being impressed with a conviction 
of the great advantages to be derived thereby. 

In addition to what we have advanced on this subject, under 
the head of irregularities of the teeth, we have some very im- 
portant observation to make on a method of treatment, that has 
never been practised to any extent, and we apprehend, never 
will, such will ever be the repugnance to it, both of the parent 
and child. The dentist too, from conscientious motives, will 
scarcely undertake the unpleasant task of endeavoring to en- 
force its propriety and importance, or to remove unfounded 
prejudices: much less for the paltry fee! It is this. — In all 
cases, where there is a certainty of the teeth being crowded 
together when the child shall have grown to maturity, (which 
is in the power of ever}^ scientific dentist to foretel,) especially, 
if there be a predisposition to decay, (which can with certainty 
be predicted from the teeth of the parents and other circum- 
stances,) we would most strenuously recommend the sacrifice 
of the four posterior bicuspid teeth, for the great benefit of pre- 
vention of decay in the other teeth ! 

"Inconsistent/' "monstrous absurdity," "preposterous 
folly," we hear our readers exclaim ! but hold till we give all 
our reasons for this treatment. We do. confess, that we should 
have no small degree of hesitation, in thus boldly recommend- 



100 Preventive Treatment of Caries, 

ing a practice so contrary to the laws of nature, and so repug- 
nant to the feelings, did we not feel that it is a most judicious 
one, supported by the strongest facts, and wholly divested of 
theory, fancy and hypothesis* 

By the early extraction of these teeth, the anterior teeth 
will fall back, and the molares will come forward, so that when 
the teeth and jaws are fully formed, there will be no vacuity 
in the latter, and when the child shall have grown to years of 
maturity, the teeth will be beautifully and symmetrically ar- 
ranged, standing a very little asunder, especially the bicuspides 
and eye teeth, and this great advantage gained, that they are 
not apt to decay, to be lost or disfigured by disease, and that 
little is to be apprehended comparatively from tooth ache, or 
being mulced in the heavy expense of artificial teeth, or the 
operation for the cure of decay. 

That this treatment is against the laws of nature, has no 
weight in argument against it, for civilized man is an artificial 
animal, subject to a thousand diseases, from which, in his 
natural state he is exempt; consequently, it is necessary to 
trespass upon her laws, to obviate the effects of luxury and 
refinement. As the anticipation of an incipent disease of the 
general system, by appropriate remedies, will often nip it in 
the bud, and thus prevent its maturity and consequences, so, 
may we anticipate and prevent the diseases of the teeth ; but 
it will often require a bold and decided practice. 

The cruelty of the treatment or pain of extraction, is no argu- 
ment against its practice ; for the fangs of these teeth, at the 
time we recommend their removal, are scarcely half formed, 
and hence can be pulled out ina few moments with the forceps, 
and with very little pain to the child: indeed, the extraction of 
these four teeth will scarcely cost more pain, than of one, 
when the fangs and jaws are fully formed. 

The bicuspides of the upper jaw are among the first to de- 
cay, and as they decay on their contiguous sides, the disease 
often makes such progress before it is detected, that it is difri- 



Preventive Treatment of Caries, 101 

cult to make the operation of plugging efTectural. Indeed, in 
the manner they are plugged by many dentists, the operation 
is of little utility. Hence another powerful reason in favor of 
our treatment. 

We would not by any means, recommend this practice to be 
universally pursued, for it would be unnecessary and highly 
improper ; but in all those cases, where there is a certainty of 
the teeth being crowded from conformation of the parts, wo 
believe it cannot be too strongly recommended. 

The utility of what we have been recommending, is often 
manifested by the treatment employed to remedy permanent 
irregularity of the teeth; namely, the extraction of four of the 
bicuspides. 

There is one exception to this practice, even where the teeth 
will be crowded. It is this. — The first permanent molares, 
are often very defective in their structure, and decay at an 
early age. In this case, these teeth should be removed instead 
of the bicuspides ; but when there is a certainty of their effec- 
tual preservation by operation, they should never be extracted, 
for they are larger and more valuable teeth, less liable to decay 
than the former, vastly more painful to extract, and the 
changes before mentioned do not take place so admirably. 

Sometimes the first permanent molares decay so early 
and so rapidly, that it is not possible to preserve them ; 
even by ten or twelve years of age their crowns are half de- 
cayed away. In all such cases, they should be extracted, 
whether the anterior teeth be crowded or not, in order that the 
changes before mentioned may take place. This treatment 
cannot be too strongly recommended, for tooth ache will com- 
pel their extraction sooner or later, when the parts being fully 
formed, no favorable changes will take place, and there will 
be large vacuities in the jaws. If these teeth be early extract- 
ed, the back teeth will partly come forward into their places; 
and another great advantage, the wisdom teeth, which are 
often small, malformed and apt to decay, will generally come 



102 Preventive Treatment of Caries, 

in larger and better formed, on account of the increase of room 
for their developement. 

When it is deemed proper to pursue either of the above 
methods of treatment, the four corresponding teeth should be 
removed for reasons that will soon be given. One thing of 
great importance remains to be mentioned.— The first perma- 
nent molares are not to be extracted till the second permanent 
molares have so far advanced in their formation, that there be 
no danger of injury to them by the operation. (See page 41.) 
When the second molares are about to cut the gum, is a proper 
time for their removal. 

" Irregularities of the teeth, and a crowded state of the teeth 
are the chief predisposing causes of their diseases, and seldom 
fails even 'in the most healthy constitution to destroy the best 
set of teeth, unless properly attended to. 

"By an early and judicious application of the necessary 
preventive treatment, I have never failed to obtain such a set 
of healty and beautiful teeth, as might be preserved to the end 
of life. 

" As it is often necessary to extract some of the permanent 
set, at an early period, in order to give sufficient room for the 
rest, it is a matter of great importance to know which teeth 
should be extracted for this purpose. 

" Those teeth which are the most subject to disease, least 
important, and the removal of which would afford the most 
relief to the whole set, are the proper ones to be extracted. 
As the loss of the incisores and cuspidati greatly disfigures the 
set, they ought always to be preserved if possible. I have 
hardly ever seen a case in which it was necessary to extract 
any of them, with a view to give room to the rest, where early 
attention had been paid to the state of the teeth. The pre- 
servation of the bicuspides should also be a matter of con- 
sideration. 

"The first molares are the most predisposed to decay, and 
are so situated as to afford, by a timely removal, sufficient 
room for the anterior teeth, as well as the second and third 



Preventive Treatment of Caries, 103 

molares. If these teeth are extracted at any period before the 
age of twelve years, ail the anterior teeth will grow more or 
less backwards, and the second and third grinders so much 
towards the anterior part of the mouth as to fill up almost com- 
pletely, the space caused b\' the removal of the first molares. 

" In almost every instance all irregularity will be obviated 
by this treatment; but besides this advantage, another impor- 
tant benefit will invariably follow ; namely, all the teeth will 
be improved in health and strength, especially the wisdom 
teeth. I have seen many instances, where by this treatment, 
these teeth have penetrated the jaw much sooner, proved of a 
larger size and possessed a better organization than usual, on 
account of their having more room for developement, and 
more plentiful nutriment, from the healthy action induced in 
the parts, 

"I must here particularly observe, that to obtain these desi- 
rable effects, it will be absolutely necessary that all the four 
molares should be extracted. The partial removal of these 
teeth will not only be entirely useless in most cases, but will 
sometimes even prove the cause of irremediable irregularities: 
for instance, the molar teeth being extracted on one side, and 
not on the other, the remaining teeth, during youth, will take 
an inclination to the side from which it has been removed ; and 
if one or both of these teeth be extracted from the upper, and 
not from the under jaw, or vice versa, considerable dispropor- 
tion between the two jaws will be produced." — Koecker. 

44 The first permanent molares often become carious soon 
after they appear: the removal of these teeth when decayed 
aught always to be recommended, although they may not oc- 
casion pain, or there be no irregularity of the front teeth ; (but 
especially, if these teeth be irregular or crowded together,) 
diseased teeth aUvays affect the others, therefore ought never 
to be N permitted to remain in the mouths of children. 

41 If they be extracted before the second permanent molares 
appear, in a short time they will not be missed, because the 



304 Curative Treatment of Caries. 

bicuspides will go back, and the second and third molares will 
come forward, so that no space will be left. 

44 The front teeth will also derive much benefit from this 
gain of room, as they will probably separate so as to leave a 
small space between them, which will tend greatly to their 
preservation; for it is observed, that when teeth are crowded 
together, they almost always fall into a state of decay ." — 
Fox's Natural History of the Teeth, part I, page 63. 



CURATIVE TREATMENT OF CARIES> 

Plugging and filing are the only means of arresting or car- 
ing decay of the teeth. The utility and proper application i>£ 
them may be considered under separate heads. 

PLUGGING THE TEETH. 

The utility of plugging the teeth for the cure of caries, as 
now practised by scientific dentists, is known and appreciated 
by many persons ; by more, it is not sufficiently known or 
understood, to induce them to have recourse to the operation, 
or if they do, to employ such services, as shall prove of much 
advantage. There are others who distrust its utility altogether. 
For the information of all, we shall present a mass of author- 
ity and facts, from the best dentists of the age, that must carry 
conviction to the mind of any reasonable man. 

44 Stopping or plugging the teeth, is the filling up of cavities 
produced by decay, with* some artificial substance. This ope- 
ration is of great antiquity. It was known to the ancient 
Romans ; and even Galen and GEtius, among the Greeks^ 
treat of it in their writings.* 



* Dental surgery, as it is now practiced on principles of science by 
all thorough dentists, is comparatively of recent origin, though some 
writers fond of ancient lore would have us believe, that it is coeval with 
the earliest ages. Mechanical dentistry, or the substitution of artifice! 



Plugging the Teeth. 105 

14 By this beautiful and useful operation, carious teeth may 
be preserved for many years ; inmost instances, during the 
remainder of life ; and, not unfrequently, from ten to tweuty 
teeth may be erTeetually preserved by this operation, in the 
same individual." — Koecker, page 381. 

44 There is no subject conuected with dental surgery, of more 
importance than that of stopping. There is none better de- 
serving the attention of the student, nor is there any in which 
the dentist may more successfully display his professional 
skill. 



teeth, was undoubtedly practiced in very early times, as personal appear- 
ance and ornament have ever had considerable influence with mankind. 
It was certainly practiced among the Greeks and Romans, and even by 
the Egyptians and Arabians. In their medical works are also found direc- 
tions for the performance of some operations for the cure of the diseases of 
the teeth, gums and sockets; but we find very little said of the proper sur- 
gical means to be employed for the prevention or cure of decay. They 
never plugged decaying teeth until the disease had formed large holes 
in them, when they plugged them with lead or gummy cements, without 
half extirpating the decaying and dead parts. Hollow, aching teeth, 
they generally used to plug with lead, previously to the performance of 
the operation of extraction, with their formidable instruments, in order to 
render the tooth less liable to break. 

About the commencement of the seventeenth century, the dental art 
began to be practiced in Europe as a distinct profession, but not with that 
success which attends the operations of thorough bred dentists of the 
present day. In America, forty years ago, it was scarcely practiced or 
known. 

In olden times all surgical operations were performed by menials, 
under the directions of the physicians, who were priests and poets aa 
well as physicians, such operations being contrary to the tenets of their 
religion, as well as beneath their dignity. It was not lawful for them to 
defile their sacred persons by taking the life of any animal, or even let- 
ting blood. Indeed, it is only about one hundred years since the bright 
star of surgery, which now shines with such dazzling splendor, emerged 
from the clouds of darkness that had ever enveloped it. The surgeon of 
the present day, guided by that intimate knowledge of the relative 
structures of the human frame, which he can only obtain and retain by 
eonstant conversation with the dead, attacks with success, the most 
formidable local disease, with which, the surgeons of past days did not 
dare to interfere. He even pursues it so near the very vitals of the body, 
that a careless cut of the thickness of a wafer would prove instant 
death ; and thus cheats grim death of its victim, and rescues thousands 
from an untimely grave. Here we see illustrated the great benefits to 
be derived to mankind by the cultivation of practical science, divested of 
theory and hyphothesis, 



106 Curative Treatment of Caries. 

" Were we to judge indeed, from the almost innumerable 
cases of failure which occur, we might conclude that the un- 
certainty of the operation was so great, as essentially to 
diminish its utility and importance. These cases however, 
occur under the treatment of ignorant persons, who are alike 
incompetent to the mechanical and surgical part of the opera- 
tion, and who are equally incapable of choosing a proper time 
for its performance."— Snell, page 151. 

44 The benefits of the operation of stopping the teeth are so 
truly important, that it is impossible to recommend it to earn- 
estly to the public ; for thousands of the most useful teeth, 
which otherwise would, on account of their painfullness, be 
sacrificed by extraction, may thus be preserved, not only for 
many years, but for the remainder of life. It will always 
succeed, if early and properly performed." — Parmhfs Notes 
to Brown's Dentologia, page 143. 

44 In a practice of upwards of twenty years, I do not remem? 
ber a single instance of failure in the operation of plugging 
teeth, favorable to be operated on, unless it could be traced to 
some untoward circumstance. I have lately been removing 
tin pluggings, (the juices of the mouth having oxidated and 
dissolved away the metal, so as to expose the teeth to decay ) 
from teeth which I plugged more than ten and fifteen years 
ago, for the purpose of re-stopping with gold, and have in almost 
every instance, found the bone of the teeth at the bottom of 
the pluggings, perfectly sound and protected from decay." — /. 
R. Spooner, (of Montreal,) 1833. 

44 Plugging of the teeth, if properly done is one of the most 
useful operations in dental surgery. 

44 If well done the preservation of the tooth will be in al- 
most every instance complete."— Fitch on the Teeth, page 378. 
44 A gentleman has just paid me a visit who has been my 
patient since the age of eight. During one of his vacations I 
saw some incipient disease and stopped it : twenty years have 
elapsed, yet I found the same old stopping which I had insert- 



Plugging the Teeth, JOT 

ed in one of the large double upper permanent teeth, and also 
in one of the large double under teeth. 

tk In 1783, applied to me James Russel, Esq. On examin- 
ing his mouth, 1 discovered considerable decay in one of his 
large double under teeth, and after cleansing out the cavity, I 
plugged it. Mr. Russel lately informed me that the same 
stopping and tooth remain perfect and firm to this day, (1825.) 

" [ have no hesitation in affirming this to be one of the most 
important and useful operations that can be performed."—? 
Sigmond. 

M The author had lately an opportunity of curing and after- 
wards plugging with gold a carious and tender tooth, for one 
of our most celebrated professors of music ; a cavity in the 
other side of which tooth had been successfully stopped, thir-? 
ty-six years before, by the father of the celebrated Talma. 
He is also acquainted with the case of a well known medical 
man in London, who has a serviceable tooth which has been 
plugged forty-seven years." — J. P. Clark, page 69. 

We have seen a great number of teeth, which have been 
plugged ten, fifteen and twenty years, and are still perfectly 
sound. We have twelve teeth in our own mouth, some of 
which were operated on near seven years ago, and as yet they 
do not show the least symptom of farther decay. We have 
extracted many teeth plugged long before, and the pluggings 
still remaining firm, decay having attacked other parts of the 
teeth and caused their destruction. Finally, every dentist 
who has practiced his profession on principles of science and 
integrity, will bear the most unequivocal testimony of the 
utility of plugging decaying teeth in the first stage of the 
disease.* 



* "If the operation of plugging- is so useful and sure of success, how 
is it that, it so often fails, and is of no utility whatever ?" is a question 
often asked us. — We answer, that such operations have not been properly 
performed — that such services, as would ensure success, have not been 
secured — that an empiric has been employed, or an ignorant incompetent 
person, for the sa"ke of economy. There are very many persons, " a 



108 Cwrative Treatment of Caries. 

That the operation of plugging a carious tooth may be per- 
fectly successful, it is necessary that the tooth be favorable to 



penny wise and a pound foolish," who employ "cheap dentists," think- 
ing the dental art to be wholly mechanical — that it does not require 
much science to practice it, and that one man can serve them as well as 
another, and for half the fee. " This is the rock on which such persons 
split," as far as the preservation of their teeth is concerned. 

The operation of plugging, in order to secure complete success, must be 
performed in the nicest and most substantial manner, and under iavorable 
circumstances. It cannot be hurried, for it is often extremely difficult, 
and requires much patience, both on the part of the operator and patient. 
Mr. Koecker justly observes, that " many dental operations are as difficult 
to be performed as any in general surgery, though the consequences, of 
course, are not so serious." It is here that incompetent persons fail, they 
do not half extirpate the disease, or properly fit the cavity for retaining 
the plugging, which they then fill in such a careless manner, that it 
soon falls out, or the juices of the mouth and foreign matter being ad- 
mitted, the tooth decays. One of those persons who adorn our profession, 
lately told us, with great gravity, that he could plug forty teeth in a day, 
and as well as any man in town ! For our own part, we are not asham- 
ed to confess that ten or twelve teeth, as a general rule, are as many as 
we ean well plug in the same time, and work hard, We have sometimes 
spent an hour and a half upon a single tooth, where the operation has 
been very difficult. 

It may not be inappropriate for us to point out in this place, the differ- 
ence between the practice of a thorough and scientific dentist, who under- 
stands the laws of the animal enconomy— the laws which govern disease, 
and the principles on which disease must be treated in order to effect a 
cure; and that of an ignorant person, who knows nothing of these laws, 
&c. Also the great advantage that would be derived to community, if 
means could be adopted to put down quackery, and to make " every man 
worthy of his hire," by obtaining a g®od medical education. Further- 
more, that our reasons for condemning quackery in the dental art, in the 
strongest manner, are not founded in prejudice or illiberality, but in a 
sense of duty that we owe to community, to our subject, and to our pro- 
fession. 

We believe that neav one half the diseases of the teeth, may be wholly 
prevented by the early and judicious application of proper means. To 
effect this great object, will require a man, having a thorough knowl- 
edge of the causes of these diseases and of disease in general, of the 
natural history of the teeth, &c— in a word, a man having at least, a 
knowledge of the general principles of both medicine and surgery, that 
he may know what remedies are proper, how to direct them, and what 
will be their ultimate results. (Ses page 26> 41 to 44.) An ignorant 
person, no matter how honest his intentions may be, cannot evidently, 
properly apply the necessary means for the preventive treatment of the 
diseases of the mouth, though this treatment, if properly directed, will 
prove of more advantage to community than the curative treatment of 
those diseases. He cannot treat irregularities of the teeth ; if he attempt 
it, ten to one, that he does more mischief than good, and often produce 
the very state of teeth, he endeavors to prevent.— (See pages 25 and 42.) 



Plugging the Teeth. 109 

be operated on, the disease perfectly extirpated, and the cavity 
plugged with gold as solid as the hills, so as completely to ex- 



The curative treatment of the diseases of the teeth, as practiced by 
ignorant or incompetent persons, is of very little advantage j nay, it is 
often of great injury. When they plug teeth, (not knowing the causes 
of the disease and how it should be treated,) they do not perfectly extir- 
pate the disease, or properly fit the cavity for retaining the plugging, nor 
do they properly fill the cavity after it is fitted ; hence the diseases pro- 
gress, the plugging comes out, and the unfortunate individual condemns 
the dental art. The operation of plugging the front teeth and small 
double teeth, is extremely difficult of performance, and requires great 
patience and dexterity. The plugging of these teeth, as it is done by 
the mass of dentists, is of little or no advantage. It is only the thorough 
going, well informed men of integrity, who overcome the difficulties and 
render such services as shall triumph over the disease, and cannot be too 
highly appreciated by those who require them. 

The effects of the mal-practices of ignorant persons or impostors, are 
often displayed in the operation of fding the teeth. They often file the 
teeth asunder, even when perfectly sound, for the prevention of decay, 
"for fear they will decay" as they term it, with rough and coarse 
files, and leave the sides unpolished. This practice of gross, preposter- 
ous and villanous imposition, has been practiced to a great extent in the 
country, by travelling empirics, and has been productive of great in- 
jury ; for the country people, not generally taking so much care of their 
teeth, to keep them clear of foreign matter, as those in the cities, would 
be apt to suffer most from this imposition. The manner in which the 
teeth are often mangled, cut up, and disfigured by such persons, is dis- 
gusting and makes an honest man blush for his profession. 

The fiie properly and judiciously employed, or as it is used by all 
good dentist (see filing the teeth,) is one of the most useful instruments 
we possess for the cure of incipent decay. 

The evil effect of ignorance, or a want of knowledge of the laws 
which govern the animal economy, — the necessity or importance of 
science in the practice of that part of the dental art, which "every body 
considers to be wholly mechanical, and that it does not require any, or 
much knowledge to practice it properly — and the advantage that would 
accrue to community, if scientific men only were employed, are displayed 
in a striking manner, by the substitution of artificial teedi on plates, as 
practiced by many dentists. The plates do not properly fit — they press 
hard against the adjoining teeth, and the clasps or springs, by which 
they are attached to the adjoining teeth, are too small or grasp too 
firmly. The dentist tells his patienif, that the teeth will feel awkward for 
awhile, but that he will soon become accustomed to them. This is the 
case, but what is the result 1 The effects of this pressure exerted ? of the 
springs ? Mark well, for the results we are about to mention, very 
generally attend the substitution of teeth on plates, attached to the 
natural teeth. 

First — The undue and continued pressure causes the teeth to which 
the artificial ones are attached, to become diseased in the socket, and 
nature sets herself to work to remove the cause of irritation, in conse- 
quence of which, they protrude by degrees, and at length fall out, 



110 Curative Treatment of Caries. 

elude all moisture and the atmosphere. If the cavity be un- 
favorable for fiiling, or cannot be made so that it shall retain 



Clasps which are too small or grasp too firmly, produce the same effect, 
and also occasion the teeth to decay, and often to become so exquisitively 
sensitive, that the artifical teeth cannot be worn, or with great incon- 
venience. We see the effects of these mal-practices illustrated every 
day. We have two such cases on hand at this time. In one case, the 
four incisor teeth were attached to the eye teeth, and was done by a first 
rate mechanical dentist, and beautifully executed, but unfortunately for 
his patient, he knew, nothing of the laws of the animal economy. The 
effects of pressure in less than two years, has caused the ruin of the 
teeth to which they were attached. The other is a similar instance of 
mal-practice. It is a common observation among mechanical dentists, 
"that plates are ruin to the teeth.-" The reason is, that they do not 
properly adapt their plates and teeth to the parts. They do not make 
them fit so as not to exert too much pressure, for pressure applied to any 
part of the animal frame, will cause changes to take place in such part. 
We have seen individuals who have been obliged to have cases made 
at different times, in consequence of the loss of teeth, to which the arti- 
fical ones were attached, caused by the improper manner of attaching 
them. Is it not evident then, that to practice even mechanical dentistry 
as it should be, requires a man possessing considerable knowledge of the 
laws which govern the human system ? 

The treatment of the diseases of the gums, sockets, and maxillary 
bones, which fall under the care of the dentist, in order to effect a cure, 
requires considerable knowledge of medicine and surgery. The igno- 
rant person does not, and cannot treat these diseases with success. His 
treatment only aggravates them. 

We trust that enough has been said to show that dentistry, in order to 
prove of utility, must be practiced on principles of science and integrity. 
Every part jpi our country is overrun with ignorant and pretending 
persons, who assume to discharge the functions and duties of this 
profession ; and having dignified their names with the title of Doc- 
tor, they travel about the country, imposing upon the people, doing 
their teeth a vast deal of injury, in consequence of which the profession 
is degraded, and public confidence to its utility almost wholly de- 
stroyed. 

Nor are these sapients confined to the country; they abound in our 
large towns also. There are 70 or 80 dentists in New York. Out of 
these Mr. Family informed me that he thought there were about 20 
who understood their profession, and practiced it faithfully. 

When we consider these facts, it is not at ail surprising, that so many 
of our citizens should distrust the utility of dental surgery, and that so 
many opinions should prevail on the subject. Quackery in any 
country, depends upon community. If it be patronized it will flourish. 
The opinion which very many persons entertain, that dentistry is wholly 
a mechanical art, and that it does not require much science to practice 
it, is highly conducive to charlatanism, and leads many to be imposed 
Upon. 
The following case, which occurred to us sometime ago, aptly illus- 



Plugging the Teeth. Ill 

the plugging securely, the operation will be of little use. If 
the tooth be very much decayed, so as badly to expose the 



trates the inutility of dental operations, unskillfully or improperly per- 
formed, and the prejudicial effect of such operations on community. 
November, 1832, called to extract some aching teeth for the 

daughters of Mr. . Found many of their teeth decaying : the 

young ladies informed me that their teeth were plugged two years 

ago by but that the pluggings soon fell out: there were very few 

remaining, and these did not protect the teeth from decay, on ac- 
count of the imperfection of the operation. After the extraction of the 

teeth, represented to Mr. what might be done for the preservation 

of those decaying. He replied to this effect : 

" Sir you will pardon me when I tell you, I have little faith in the 
means you recommend for the preservation of my daughters' teeth. 1 
have spared no expense that they might be preserved. They were all 
plugged two years since, for which I paid 150 dollars, yet you say the 
operations have failed. I believe they have been more injured than bene- 
fitted, and that this plugging and filing the teeth break up their struc- 
ture and make them decay more rapidl} 7 . 55 

Feeling the just reasons for his prejudice, we repressed our rising 
indignation, and without further parlance took our leave, regretting ex- 
ceedingly that our profession should be disgraced by such imposition. 
There is nothing more cutting to the feelings of an honorable mind, than 
distrust of its integrity. It cuts to the hearts core. He cannot stifle his 
honest indignation. The mercenary wretch bows in humble submission^ 
and uses his smooth and flattering tongue to effect his purpose. 

We think it unfortunate for community, that any man can practice 
dentistry who chooses, for it fills the profession with incompetent persons, 
who fleece those who employ them without confering any benefit, 
but often doing them much injury. The dental profession should be 
protected &y legislative anactment : every person before he be permitted 
to practice it, should ser^e a term of pupillage, and pass an examination 
before a competent board of surgeon dentists ; this would fill the profes- 
sion with honorable men ; men who would serve their patrons with 
fidelity and success ; and that too, at a more reasonable rate, than is paid 
by many for the preservation, or rather destruction of their teeth. We 
believe that most persons who have lost their tee'h, might have had them 
preserved, at a far less expense, than they have paid for artificial ones. 

Dental surgery is now practiced ly the honorable and well educated 
members of the profession, in our country m very great perfection, and I 
am proud in believing, that it is generally practiced by them better than 
in any other. 

"In the United States of .America, although little or nothing has been, 
done in the way of publishing upon the subject of Dental Surgery, yet 
I feel myself authorized to say, that in no part of the world has this art 
attained a more elevated stariom 

" The operative part is by far more extensively cultivated, and has 
arrived at a state of excellence much greater in that, than in any other 
country to my knowledge, but unfortunately this superiority is only to 
be found in the practice of a very limited number of men of talents and 
principles." — Koeckcr, page 20. 



112 Curative Treatment of Caries. 

nerve, the operation must often be unsuccessful. If the opera- 
tion be not properly performed, it is, at best, of little use, and 
often of positive injury. Hence ignorant persons and impos- 
tors do injury to community, and degrade the dental profession 
below its deserved standing. 

As soon as a tooth begins to decay, the disease should be at 
once extirpated, and if necessary the cavity filled. There are 
great advantages to be derived from this procedure ; for inci- 
pient decay, especially of the front teeth, may often be effec- 
tually eradicated without the operation of plugging. If it be 
necessary to plug the tooth, the decay can be cut away, with 
proper instruments, in a short time, often with little or no pain 
to the patient, and the operation is always sure of complete 
success, if properly performed. There will be no inconven- 
ience experienced afterwards, and the patient will feel his 
teeth sound, as though nothing had been done to them. 

It is a great mistake with most individuals, that they do not 
apply to the dentist early enough, to obtain the greatest possi- 
ble benefit from his art. Many do not think of the preserva- 
tion of their teeth, till tooth ache, a faithful monitor of the 
future, compels them to seek relief, when perhaps some of 
them may have so much decayed, that little can be done for 
their preservation ; or at least, the operations are much more 
tedious and painful, and not so sure of- success. Hence, in a 



The few well educated members of our profession, in New York, 
have been using- their best endeavors to elevate it to its proper rank and 
usefulness. For this purpose, a " Society of Surgeon Dentists," has 
been formed, for the honorable and laudable purpose of mutual im- 
provement. 

The society has organized itself, a library is being establishedj and a 
course of lectures on the subject of the profession is anually to be de- 
livered. 

It is also the intention of the society to petition the State Legislature, 
as soon as proper, for the passage of a law, to put down quackery, by 
making it necessary for those who would practice dental surgery, to 
thoroughly understand the profession, and to pass a regular examina- 
tion before a competent board of surgeon dentists ; also for a charter to 
found an institution for qualifying students to practice dentistry. Which 
measures if adopted and put into execution, will prove of incalculable 
advantage to the community. 



Plugging the Teeth. 1 13 

great measure, have arisen, the exaggerated ideas, which peo- 
ple generally entertain as to the pain of dental operations. 
Many persons who have experienced these operations, very 
much exaggerate the pain of them. They often declare that 
they had rather have a tooth pulled than one plugged, as to 
the pain they experience. This is wrong, as it serves to im- 
press those who have not had operations performed upon their 
teeth, with the idea of severe suffering. Many, indeed, are 
so apprehensive of this, that, though convinced of the utility 
of dental surgery — of the importance and necessity of having 
something done to prevent the loss of their teeth, they neglect 
them, till many of them are inevitably lost. To such, w r e 
would recommend the resolution to have some one simple 
operation performed, as a favorable tooth plugged, that they 
may judge for themselves, as to the severity of the pain they 
will probably experience under the operations, and whether 
they can submit to it. We have generally found this plan 
completely successful; for it is half the task to make a begin- 
ning, and the unfounded fears of the patient quickly vanish 
under the management of a skillful operator. 

All dental operations, save that of extraction, when early 
and properly performed, are generally attended with little 
pain, and often, none at all. We never yet saw the patient, 
w r ho had rather have a tooth pulled than one plugged, when 
he came to the " tug of war." We often see this verified ; 
for it rarely happens, that there are teeth in the mouth so 
much decayed, that they cannot be preserved and are to be 
extracted. During the operation of plugging, especially if the 
patient is irritable and the teeth uncommonly sensitive, we 
frequently hear the exclamation, " I had rather have a tooth 
pulled than one plugged," but when the former operation 
comes, " I had rather have a dozen teeth plugged than one 
pulled." 

There is a very great difference in the sensibility of the 
teeth of different individuals : some suffer much pain in having 
decay extirpated from their teeth, even far from the nerve ; 
5* 



114 Curative Treatment of Caries. 

while others do not experience the least pain. We have fre- 
quently exposed the very nerves of teeth, much decayed, and 
even wounded them during operations, yet the patient has de- 
clared that he did not suffer. Indeed, so great is the difference 
in the sensibility of the teeth, that the feelings of the patient 
form no criterion, by which the dentist judges how far it is 
safe to proceed without danger of exposure of the nerve. He 
is guided in his operation, by the anatomy of the tooth and its 
appearance. 

Much also depends upon the operator himself. We know 
from experience, as well as from abundent observation, that a 
careless and rough operator inflicts much more pain, than a 
careful and dexterous one. 

That the clread of pain of dental operations should deter per- 
sons (as it often does,) from having them performed, when 
convinced of their utility and necessity, is unfortunate for them, 
nay, foolish. If they were ten times as painful as they really 
are, it would have little influence with a resolute person, who 
values his teeth and dreads tooth ache. 

44 A stitch in time saves nine," is an old and vulgar adage. 
We know nothing, to which it can be applied with more force, 
than to the management of the teeth in every respect from in- 
fancy to old age. 

OF A FIT STATE OF THE MOUTH FOR THE PERFORM- 
ANCE OF OPERATIONS ON THE TEETH FOR THE 
CURE OF CARIES. 

The following observations of Mr. Koecker, are in our opin- 
ion very judicious : 

44 To render the operation of stopping the teeth certain of 
success, it is indispensibly necessary to remove every local 
exciting cause of inflammation, especially every disease of the 
mouth that might be considered the principal exciting cause of 
the local maladies of the teeth, before undertaking the ope- 
ration of plugging the affected teeth. 

44 When the parts in immediate connexion with the teeth, such 



Plugging the Teeth. 115 

as the gums, the alveoli, periosteum, and the maxillary 
bones, and even those more distant, are in any way morbidly 
affected, they should be previously restored to healthy action. 
" For more than thirteen years, I have made it my inva- 
riable rule, in my own practice, not to plug teeth until I have 
completely cured all the diseases of the gums, sockets and 
maxillary bones ; by using this precaution, I have seldom 
failed to be completely successful in the application of the 
remedy. ,, — Koecker, page 414. 

TREATMENT OP THE TEETH, WHEN CARIES HAS PRO- 
GRESSED TO THE NERVE. 

When decay has extended to the nerve, and causes the 
tooth to ache, extraction is the usual remedy resorted to by all 
who have sufficient resolution to induce them to undergo the 
operation. The teeth are so liable to caries in this country, 
and often decay at so early an age, and so rapidly, that it is a 
matter of very great importance to all, especially to those who 
have been so unfortunate as to lose many teeth, whether 
some means cannot be devised for their preservation. 

"When the nerve of a tooth has been so much exposed by 
decay, as to leave no hope of curing it but by extraction, it 
were much to be desired that medical science should lead to 
the discovery of some principle, that would quickly extirpate 
fleshy substances, or at least their diseases, without at the 
same time acting on the bony structure of the teeth. " — Sys- 
tem of the treatment of the diseases of the teeth, by J. P. Clark, 
A. B. pags 89. 

This desideratum has been happily discovered, and its suc- 
cess has been thoroughly tested, in a practice of^many years. 
The nerves of the teeth may be certainly and effectually de- 
stroyed, with little or no pain to the patient, and without the 
least danger, by means of a little arsenious acid, (arsenic, rats- 
bane,) applied to the nerve. 

We claim for our brother, Dr. J. R. Spooner, of Montreal, 
the credit of this invaluable discovery, and for ourselves no 



11G Curative Treatment of Canes. 

small share of credit for thus frankly laying' it before th© 
dental profession and the public. 

We have proved that the vitality of the fangs of the teeth* 
which is necessary to prevent them from acting as foreign bodies 
in their sockets, does not depend upon the internal membrane or 
nerve, (see page 57.) This fact is of greater importance than, 
one would suppose at a first view, for thousands of aching teeth 
which are daily being extracted, may be effectually preserved 
by taking advantage of it. This is a matter of much moment 
to those who have been so unfortunate as to lose many teeth. 
So complete and satisfactory is the operation of arsenic in 
destroying the living fibre, that, instead of extracting teeth 
whenever the nerve is badly exposed, we destroy it, plug 
the teeth, and thus preserve them. Teeth thus treated 
will often last a great number of years, and prove highly 
serviceable. 

Arsenic will not only positively destroy the nerves of the 
teeth, but it possesses the great advantage, that it does this 
without causing pain ! If it be applied to an aching tooth, it 
slightly augments the pain, but when applied to a nerve, not 
inflamed it does not cause any pain, worth minding ! Of late, 
we have applied to aching teeth, a mixture, composed of 
arsenic three parts, and acetate of morphine one part, the 
morphine, (one of the active principles of opium,) being the 
most powerful odontalgic remedy, (remedy for the tooth ache,) 
that we know of. Thus the most violent tooth ache may be 
effectually cured, without additional pain, a circumstance well 
worth considering. We cannot too strongly recommend this 
treatment to the public, under the circumstances we are treat- 
ing of. No selfish views evidently actuate us in making these 
declarations. They are not the puffs of pretenders. They 
are not involved in mystery, but we explain the whole. u The 
Royal mineral succedanium," involved in the mystery of 
empiricism, a worthless thing, excited great curiosity in^New 
York last year. We doubt much if this truly valuable dis- 



Plugging the Teeth* 117 

fiovery will excite any interest ; hence we are a little anxious 
to urge it. 

Arsenic is the only substance with which we are acquaint- 
ed, that will effectually destroy the nerve of a tooth. Nitric 
acid and nitrate of silver, (lunar caustic,) have been much 
employed for this purpose. They were favorite tooth ache 
remedies with Hunter and Abernethy, but they do not gene- 
rally do this effectually ; they only destroy the surface of the 
nerve ; indeed but the small portion of it exposed ; besides 
they destroy the tooth. A hot wire is the remains of barba- 
rism, cruel as death, and does not become the present enlight- 
ened day. 

A drill, as well as the hot iron, is very painful, and is enough 
to strike horror to the soul of a patient. The arsenic effects 
the object like a charm, and under proper management never 
fails of complete success. Many persons of course would be 
apprehensive of danger from its use ; the eighth of a grain of 
arsenic is a common dose in medicine; the twentieth of a 
grain is quite enough to destroy the nerve of any tooth. But 
let no ignorant person dabble with this remedy. As we re- 
commend it so strongly, it is a duty incumbent on us, to 
caution the public. There are many who would have 
no hesitation in filling a large hollow tooth with arsenic, on 
the strength of this recommendation. There are some who do 
not even know what it is ! We know of one instance, and 
but one, thank Heaven, in which the application of the reme- 
dy, was attended with fatal consequences, and we merely 
mention it as a warning to presuming quacks. 

A man having a violent tooth ache, applied to an ignoramus 
for relief, who having heard that arsenic would destroy the 
nerve, proceeded to fill the tooth which was very much de- 
cayed, with this substance and did not properly confine it. 
The man returned home: the pain continuing, he took a 
hearty dram ; the arsenic was swallowed and the man 
poisoned. 

We have used this remedy in hundreds of instances, with- 



118 Curative Treatment of Caries. 

out ever experiencing any ill effects : nor can any danger ever 
attend its proper application. 

Whenever the nerve of a tooth can be preserved, it should 
not by any means be destroyed. 

Very often in the artificial exfoliation of teeth much decay- 
ed, the nerve will be exposed before the disease can be per- 
fectly extirpated ; and if such teeth be now stopped with any 
metal, without the leaden cap, pain will certainly follow and 
compel the patient to have the teeth extracted ; but if the 
nerve be first covered with the lead, the operation is usually 
successful ; indeed, we may say, that it is rarely unsuccessful, 
if skillfully performed. The lead seems to act as a direct se- 
dative. We have often exposed the nerves of teeth, and even 
wounded them so as to make them bleed, before we could extir- 
pate the disease, and yet when treated as above, no pain has 
followed. We have often been asked,— How can a tooth be 
filled when the nerve is exposed, so that the metal may not 
press upon it, and cause pain? The reason is this: — The 
ceiling or roof of the cavity of a molar tooth, is convex, or 
rather oval, and it projects considerably into the cavity, while 
four cornua run a little towards the grinding surface : conse- 
quently, we can proceed much farther w 7 ith our instruments, 
directly in the centre of a tooth, towards the nerve, than a 
little to one side, without exposing it, and it is at one or more 
of these cornua, where the nerve is usually exposed. 

The practice of capping the nerves of teeth, was introduced 
and recommended by Mr. Koecker, several years ago, and is 
truly a valuable improvement in dental surgery. 

Lead leaf may also be used, but great care must be takenthat 
the pressure applied in forcing the plug, do not indent the leaf 
so as to press upon the nerve, in which case pain will cer- 
tainly follow. The plate of lead being thicker and more un- 
yielding, obviates this objection. Koecker and Snell recom- 
mend the nerve to be cauterized, previously to the operation 
of plugging. We think the practice a good one ; but its prop- 
er application will require more tact and ingenuity than most 



Plugging the Teeth. 119 

dentists possess. The late Mr. Hudson, of Philadelphia, used 
to apply astringents, as nut-gall, to the naked nerves to occa- 
sion their contraction, to enable him to plug the teeth. We 
doubt if this practice possesses much utility. 

We will mention for the benefit of professional readers, that 
Dr. Torrey, Professor of Chemistry in the College of Physi- 
cians and Surgeons, recommends a little asbestos to be put 
into the cavity of a tender tooth, previously to plugging. As 
it is very soft and insoluble in water, he thinks it may prove 
of great advantage. 

If the nerve of a tooth be much exposed, we think it much 
the better practice to destroy it at once, by means of the arse- 
nic, and then to plug the tooth securely. All other methods 
of treatment are often abortive, and if successful, the nerve 
often dies away gradually. 

OF THE MATERIALS PROPER FOR STOPPING THE TEETH. 

*' Materials for stopping teeth. — Various materials and 
metals have been proposed for stopping the teeth, all of 
which are more or less objectionable. Lead, tin, and silver, 
are frequently employed for this purpose, but they are all 
destitute of the properties indispensible to success, in the 
performance of the operation.' Any of these metals will 
protect the cavity from caries, for a short period only. They 
will all soon corrode, and then become more injurious than 
the original disease ; and in every case will ultimately prove 
the cause of destruction to the tooth, which might have 
been preserved by proper treatment. Although platina is a 
more suitable metal than any one of those above mentioned, 
yet, in consequence of the necessity of amalgamating some 
other metal with it, to render it melleable, it is by this adul- 
teration rendered insufficient for the purpose. It is never ac- 
companied by that cleanly and bright appearance, so desirable 
for teeth that have been stopped ; but it is productive of a dingy 
opacity of the tooth's surface, which is apt to mislead the 
dentist at a future period, into an idea of its being again 



120 Curative Treatment of Caries, 

under the influence of caries, and is therefore also objec- 
tionable." 

"Fusible Metal.— A composition used by some in this coun- 
try, and generally in France, consisting of bismuth, 8 parts, 
lead, 5 parts, and of tin 3 parts, soluble at a heat of boiling 
water, and called fusible metal. In the first place, this me- 
tallic compound is as liable to corrode as eitber lead or tin, 
and possesses all the other noxious chemical qualities of both. 

"Secondly, the metal introduced into this cavity at the 
temperature of boiling water, will not only destroy the vitality 
of the living fibres, but also the whole surface of the healthy 
bone, and thereby produce some dead bony substance and 
caries, the very disease intended to be cured by it, which will 
inevitably destroy the teeth. 

" Thirdly, the irritation of the hot metal subjects the living 
membrane of the tooth to inflammation, and destroys the 
vitality of the tooth. 

" A fourth objection is, that the metal being poured into the 
cavity in its liquid and expanded state, will contract as it 
cools ; and consequently, instead of being a perfect filling up, 
it leaves interstices for the reception of foreign matter, which 
will destroy the tooth more quickly than if the cavity had not 
been stopped at all." 

"In fact, gold is the only metal, the durability of which can 
be depended upon and which combines all the advantages re- 
quired for the due performance and success of this difficult 
and important operation. It is the softest and most melleable 
metal ; it will never corrode, and it produces the most beauti- 
ful effect upon the appearance of the tooth stopped with it, so 
much so indeed, that a front tooth which is properly plugged, 
in such a manner that the gold is not seen, is actually improv- 
ed, not less in appearance tban in health. 

"Even gold as it is often prepared for the dentists, though 
free from copper, is not unfrequently alloyed with silver, 
which renders it harder and in some measure liable to corrode, 



Plugging the Teeth. 121 

and is therefore in this state to be rejected."*— Koecker, pages 
892, and 405. 

cements; 

Various substances in the form of cements have been used 
iQ past ages, and are still, for the purpose of filling decayed 
and hollow teeth. All such substances are of very little use 
for the preservation of the teeth ; they are at best, only pail- 
atives, and are never used by honorable and well informed 
dentists, unless for a temporary purpose. Cements are com- 
posed of earthy substances which have the property of hard- 
ening under water, (as tufa and terras, which are com- 
pounds of iron, silex, allumine, and carbonate of lime,) mixed 
with the filings of metals, usually of zinc, in order to render 
them harder ; also of metals amalgamated with mercury; 

Auy person who is at all acquainted with the principles bri 
whicli a carious tooth must be plugged, that it may be cured, 
will at once perceive, that no cement can ever be devised, that 
shall prove of much utility for the purpose of Filling decaying 
teeth. In order that a carious tooth be cured and protected 
from future decay, it is necessary that the decayed and dead 
portions be completely cut away, and the cavity plugged air 
and water tight. Cements do not, nor can they ever be con- 
trived to effect their object We have seen many teeth stop- 
ped with cement, and it may be well to mention (he result of 
one case. In 1832, a lady called on us for the purpose of 
having a tooth extracted, which had two years previously 
been stopped with cement in London. She had four other 
molar teeth operated on at the same time. We recommended 
the cement to be removed, and the teeth plugged with gold, 
which she did not prefer to have done. In less than two years 
from this time, we extracted all these teeth. 

We would not dwell upon this subject, were it not that 
empirics are imposing upon community things which they 
know to be useless. The success of those ignorant impostors 
6 



122 Curative Treatment of Caries. 

and impudent empirics, the Crawcours,* last year, in this city 
with their " Royal Mineral Succedaniurn for plugging carious 



* These swindling villains are said to have made a handsome fortune, 
in the short space of a few months, without conferring the least benefit on 
their dupes. They took good care to fill their coffers out of the purses 
of the good citizens of New York, (many of whom, by the by, are very 
fond of patronizingjforez^i, instead of native merit,) till compelled to 
flee the country, when they "returned to good old England to enjoy the 
yankee spoil." 

We are acquainted with a respectable physician who actually allowed 
these fellows to remove gold plugging from his teeth, that they might be 
filled with the " Royal Mineral Succedaniurn." 

" Credulity is a far greater source of error than superstition ; for the 
latter must always be more limited in its influence, and can exist only, 
to any considerable extent, in the most ignorant portions of society ; 
whereas the former diffuses itself through the minds of all classes, by 
which the rank and dignity of science is degraded, its valuable labors 
confounded with the vain pretentions of empiricism, and ignorance is en- 
abled to claim for itself the prescriptive right of delivering oracles, 
amidst all the triumphs of truth, and the progress of philosophy." 

"It is the love of simplicity, the marvelous and the fatal credulity of 
mankind, that have ever patronized empiricism; hence the effects cf 
charms, incantations and amulets in the cure of diseases. A certain 
physician cured his patients, by administering to their immagination, a 
powerful and efficacious medicine, which, if they did not exactly follow 
his directions, would certainly kill them, but if they did, as certainly 
cure. This wonderful penacea was a bread pill. Pulverized rats skulls, 
were once celebrated in the cure of dyspepsia ; vipers tails, baked 
toads, and the ossa triquetra, in the cure of epilepsy." 

u Mystery is the very soul of empiricism ; withdraw the veil and the 
confidence of the patient instantly languishes; thus Pliny, 'minus 
credunt quae ad suam salutem pertinent, si intelligunt.' ' Patients have 
less faith in the efficaey of medicines administered to them, if they know 
what they are." — Paris' Pliarmacologia. 

While on the subject of empiricism, the reader will excuse a few ob- 
servations, on what is termed by some, "the new practice of medicine," 
called Homoeopathia. The following are the principles, on which ho- 
moeopathic medicine is founded. 

" 1st. All simple drugs given to individuals in healtrfproduce in them, 
under all circumstances, certain definite morbid symptoms, which are 
termed drug-symptoms, and which are similar to the symptoms observa- 
ble in certain corresponding natural diseases. 

"2nd* The direct curative power of each simple drug, and of all medi- 
cines generally consists exactly and exclusively in the similarity of the 
symptoms of a natural disease to their corresponding drug-symptoms, 
or to those produced in healthy individuals, by administering certain 
simple drugs to them ; so that all other operations of drugs are to be 
considered as capable only of admitting recovery indirectly, or by 
chance. 

" 3d. All natural substances, but especially all drugs, acquire by cer- 
tain mechanical processes, certain medicinal power, so that any quantity 



Plugging the l\eth, 123 

teeth, in a few moments, without the least pain, and thereby 
preserving them through life," illustrates the importance of 



of the substance or drug in question, however small, will always operate 
absolutely and unconditionally as an effectual remedy in its appropriate 
disease, by its specific power properly developed, which power or virtue, 
however, increases ad infinitum, in the direct ratio of the mechanical 
processes mentioned, and m the inverse ratio of the quantity of the sub- 
stance." — Lee- Wolf on Jtlomceopathia, page ' 

The following observations on homceopathia, which we transcribe from 
the Evening Star, July, 1335, are so apropos, that we beg to present 
them to the reader. 

11 Of all the stupendous humbugs that ever flourished and fattened up- 
on the credulity of mankind, not excepting the mountebanks of the dark 
ages of alchemy and necromancy — not excepting the more modern im- 
postors of Mesmer and his magnetism, Perkins and his tractors, and 
Hohenloe and his incantations, — the greatest by far is the famous Samuel 
Hahnemann, author of Homceopathia. For more than twenty years 
this indefatigable clamorous impostor under the imposing disguise of a 
more than ordinary share of erudition for persons of his stamp, has 
been struggling to make proselytes to the sublimated nonsense which he 
has from time to time published under the pedantic title of Homceopa- 
thia, and the still more audacious assumption of the sacred name of Ba- 
can's immortal Organon. He has, the more effectually to dupe the 
unsuspecting, usurped this latter title to his crude and mystified dogmas, 
under the pretext that his discoveries and doctrines will effect an entire 
revolution in medical philosophy, and totally annihilate the u learned 
lumber" which has been accumulating from the pens of physicians since 
the first dawn of the science. 

" Hahnemann, by a process of reasoning peculiar to himself, relies on 
the extreme minuteness of his doses, — infinitesimal quantities procured 
by excessive dilution and laborious trituration, or comminution of his 
medicaments into their ultimate atoms — the greater the subdivision, the 
greater the efficacy ! A grain of tartar emetic dissolved in Lake Superi- 
or, would be infinitely more efficient than in 4 oz. of water, &c. So 
puerile a proposition strikes the plainest understanding as the very cli- 
max of stupidity, and its only good moral effect would be in eradicating 
the vile habit cf eating medicine, practiced by old women and hypo- 
chondriacs, and in causing mankind to rely more on a proper regimen of 
diet, dress and exercise, rather than on dangerous mineral or vegeta- 
ble poisons, placed in the hands of inexperienced adventurers. We shall 
not stop, however, to refute so ridiculous an hypothesis, nor enter into 
metaphysical disquisitions, as to the support it might obtain by deducing 
analogies from atomic affinities, as established by the late discoveries in 
chemical science. We do not wish to throw a veil or gloss over a sys- 
tem of incomprehensible and irreconcilable contradictions, the object of 
which-, on the part of the author, has clearly been to mystify and dupe the 
understanding, and to plunder the pockets of his fellow creatures. We 
leave him to the remorse of his own conscience and the patronage of 
Queen Adeliade, and the other meddling and imbecile personages of royal 
and noble blood. But for a detailed and most profound and elaborate dis- 
section of this preposterous humbug, we refer our readers triumphantly 



124 Curative Treatment of Canes. 

this subject, by showing how fond we are of believing whal 
we could wish to be true. Cements are kept by some of the 



to the erudite work of Dr. Leo- Wolf, whom we are proud to honor as a 
member of the profession, and whose admirable analysis of Hahne- 
mann will redound to his honor, when the works of authors less unpre- 
tending will have been forgotten.'' 

u Gambling," says the historian Gibbon, "is a natural propensity of 
man." It has not a more fasinating charm with the gamster, than has 
mystery with the credulous man, afflicted with any disease. 

England has been termed "the paradise of quacks," we doubt if the 
term were not more applicable to our own country : for quacks in every 
department of the healing art are swarming the land; steam doctors, root 
doctors, Indian doctors, bone setters or doctors, and lastly tooth doctors. 

We cannot look into a newspaper of the present day, without meeting 
with medical and quack advertisements, the most digusting to a man of 
sense, all held forth to the eager eyes of the afflicted, as panaceas, who, 
actuated by credulity or hope, grasp at them as a drowning man at a 
straw, and with as much advantage. "Doctor diet," "doctor quiet," and 
" doctor cheer," are the best physicians for the relief or cure of those 
diseases, for which patent medicines are taken by the afflicted ; and with- 
out these, conjoined with wholsome exercise, all the medicines in the 
world can be of little use. {( A quack is known by his advertisement." 
The thorough bred physician never offers a specific, for the cure of any 
disease, for he knows there are none. The administration of medicine in 
all chronic or organic diseases is of little advantage, unless accompanied 
with a strict regimen or diet. It is in the treatment of violent diseases, 
where the skill of the judicious physician is displayed. As the master 
of a ship, during a storm at sea, directs her guidance, so the physician, 
watching every symptom of the disease, endeavors to check, remove, or 
obviate the effects of all those that are unfavorable, till the storm abates. 

The effects of change of diet, exercise, recreation, &c. are Well illus- 
trated by the following extracts from Paris' Pharmacologia: 

" Let us then, before we decree the honors of a cure to a favorite me- 
dicine, carefully and candidly ascertain the exact circumstances under 
which it was exhibited, or we shall rapidly accumulate examples of the 
fallacies to which our art is exposed ; what has been more common than 
to attribute to the efficacy of a mineral water, those fortunate changes of 
constitution that have entirely or in a great measure, arisen from salubrity 
of situation, hilarily of mind, exercise of body, and regularity of habits, 
which have incidentally accompanied its potation. Thus, the celebrated 
John Wesley, while he commemorates the triumph of ' Sulphur and 
Supplication,' over his bodily infirmity, forgets to appreciate the resus- 
citating influence of four months repose from his apostolic labors; and 
such is the disposition of the human mind to place confidence in the ope- 
ration of mysterious agents, that we find him more disposed to attribute 
his cure to a brown paper plaister of egg and brimstone, than to Dr. 
Fothergill's salutary prescription of country air, rest, asses milk, and horse 
exercise. The ancient physicians duly appreciated the influence of such 
agents ; their temples, like our watering places, were the resort of those 
whom medicine will not cure, and we are expressly told by Plutarch that 
these temples, especially that of Esculapius, were erected on elevated 



Plugging the Teeth. 125 

apothecaries, and held forth by those interested in the sale of 
them as specifics " with which every person can plug his own 



spots, with the most congenial aspects; a circumstance which when 
aided by the invigorating effects of hope, by the diversions which the 
patient experienced in his journey, and perhaps by the exercise to which 
he had been unaccustomed, certainly performed many cures. It follows 
then, that in the recommendation of a icatering place, something more 
than the composition of a mineral spring is to direct our choice, — the 
chemist will tell us, that the springs of Hampstead and Islington rival 
those of Tunbridge and Melvern, that the waters of Bagnigge Wells, as 
a chalybeate purgative, might supersede those of Cheltenham and Scar- 
borough, and an invalid would frequent the spring in the vicinity of the 
Dog and Duck, in St. George's Fields 3 with as much advantage as the 
celebrated Spa at Leamington ; but the physician is well aware that 
by the adoption of such advice, he would deprive his patient of those 
most powerful auxiliaries to which I have alluded, and above all, lose 
the advantages of the ' Medicina Mentis.* On the other hand, the 
recommendation of change of air and habits will rarely inspire confi- 
dence, unless it be associated with some medicinal treatment ; a truth 
which is more easy and satisfactory to elucidate and enforce by example 
than by precept — let the following story by Voltaire serve as an illustra- 
tion. — { O^ul, a voluptuary who could be managed but with difficulty by 
his physician, on finding himself extremely ill from indolence and in- 
temperance, requested advice :— ' Eat a Basilisk, stewed in rose-water,' 
replied the physician. In vain did the slaves search for a Basilisk, until 
they met with Zadig, who, approaching Ogul, exclaimed, 'Behold that 
which thou desire st;' ' but my lord, 5 continued he, ' it is not to be eaten ; 
all its virtues must enter through thy pores, 1 have therefore enclosed 
it in a little ball, blown up, and covered with a fine skm ; thou must 
strike this ball with all they might, and I must strike it back again, for 
a considerable time, and by observing this regimen, and taking no other 
drink than rose-water foi a few days, thou wilt see, and acknowledge 
the effect of my art. 5 The first day Ogul was out of breath, and thought 
he should have died from fatigue"; the second he was less fatigued, and 
slept better : in eight days he recovered all his strength; Zadig then 
said to him, ' There is no such thing in nature as a Basilisk ! but thou 
hast taken exercise and been temperate, and hast therefore recovered 
thy health V But the medical practitioner may perhaps receive more 
satisfaction from a modern illustration ; if so, the following anecdote, 
related by Sydenham, may not be unacceptable. This great physician 
having long attended a gentleman of fortune with little or no advantage, 
frankly avowed his inability to render him any farther service, adding 
at the same time, that there was a physician of the name of Robinson, at 
Inverness, who had distinguished himself bv the performance of many 
remarkable cures of the same complaint as that under which his patient 
labored, and expressed a conviction that, if be applied to him, he would 
come back cured. This was too encouraging a proposal to be rejected ; 
the gentleman received from Sydenham "a statement of his case, with 
the necessary letter of introduction, and proceeded without delay to the 
place in question. On arriving at Inverness, and anxiously inquiring 
for the residence of Dr. Robinson, he found to his utter dismay and dis- 



126 Curative Treatment of Caries. 

teeth, as well as to employ a dentist, and at a very trifling 
expense." 



appointment, that there was no physician of that name, nor ever had 
been in the memory of any person there. The gentleman returned, 
vowing eternal hostility to the peace of Sydenham ; and on his arrival 
at home, instantly expressed his indignation at having been sent on a 
journey of so many hundred miles for no purpose. { Well,' replies 
Sydenham, ' are you better in health V — i Yes, I am quite well, but no 
thanks to you, 5 — 'No,' says Sydenham, 'but you may thank Dr. Robin- 
son for curing you. I wished to send you a journey with some object of 
interest in view ; I knew it would be of service to you ; in going you had 
Dr. Robinson and his wonderful cures in contemplation ; and in return- 
ing, you were equally engaged in thinking of scolding me.' '' 

To show the effects of diet m the cure of a disease of very frequent oc- 
currence in our city, hcemoptysis or bleeding at the lungs, we beg 
leave to mention a case, the subject of which was ourself : a desire that 
it may prove of use to others similarly affected, is our apology and only 
reason for relating it. 

In the autumn of 1833, I caught a severe cold from exposure, the effects 
of which, I took little care to remove; depending on the soundness of 
my constitution, 1 left it to nature. On the first of January following, I 
had a violent attack of haemoptysis. Knowing the danger of further 
delay, I took some medicines and put myself on a low diet, (bread and 
milk ; a diet that I am fond of,) and continued it till the middle of March, 
when, feeling myself much better at the lungs, I returned to my old 
regimen. About the first of May, the bleeding from the lungs returned 
with redoubled vigor; so much so that I fainted : it continued at intervals 
for a fortnight, and reduced me very much. I again took to the bread 
and milk diet and continued it, occasionally changing it for a vegetable 
diet, upwards of a year, (during this time I ate no animal food,) when, 
finding every symptom of my old complaint subdued, I gradually re- 
turned to a "rational mode of living." Since this time, though living 
on " the fat of the land," I feel my lungs as sound ss ever they were. 
The low diet subdued, or assisted nature very materially in subduing the 
chronic inflammation of the mucous membrane, lining the air tubes, 
which was the proximate cause of the disease. 

I have recommended the above mode of living to two of my acquaint- 
ances, affected with haemoptysis, who have followed it, and derived great 
benefit thereby. 

The milk of the ass has long been celebrated for the cure of consump- 
tion. It is the diet and charm of novelty that have been beneficial — not 
that the milk of the ass is more efficacious than that of the cow, though 
it is richer; nor is it that milk possesses any medicinal quality. It 
is the diet ; and any low diet, well managed, would prove equally effi- 
cacious. 

Physicians are beginning to treat chronic diseases on a new method. 
Instead of feeding the slow flame with a stimulating diet, they starve 
it out ; or subdue the chronic inflammation, by keeping the patient on a 
very low diet. There is no danger of persons dying from debility, in- 
duced by this diet. Nature is very provident ; give her much, and she 
will endeavor to throw it off at waste gates ; give her little, and she 



Plugging tke Teeth. 127 

" The temporary celebrity occasionally obtained by adver- 
tisers of cements, only attests the extreme disposition to gulli- 
bility of the public. Few things are more mortifying to the 
well informed practitioner, than to find his patients leaving 
him to place themselves under the care of one of these puffing 
pretenders of the day. The fashion for using cements will, 
like all others pass away, and the great number of unsuccess- 
ful cases will accelerate its progress to oblivion. It is an old 
complaint, and though old, unhappily not an obsolete one, 
that ignorant pretention, especially when wrapt in mastery, 
is more attractive to the million than modest ability. 

44 It is consoling however, to the respectable practitioner to 
know, that while empirical tricnery may confer evanescent 
fame, sound scientific aquirement, is the only basis, or which 
can be founded a reputation solid, progressing and endur- 
ing." — Snell, page 158. 



will convert it all to the purpose of nutrition In proof of this law, there 
are many cases on the records of medicine, of persons having lived on an 
astonishing small quantity of food for a long time; and again, of gor- 
mandizers whose rapacity food could no,, satisfy. 

A case is related in les Anecdotes dc Medicine^ of a French soldier, 
who is said to have eaten a whole quarter of beef in a single day : he 
used to contend with the dogs for the grocest food, and at length is sup- 
posed to have taken to cannibalism. 

There are three kinds of diet, the animal^ vegito- animal or milk, and 
the vegetable. The laboring man requires a stimulating diet or animal 
food, as the following anecdote illustrates. 

Three or four years ago, the hue and cry was raised in New York, 
that the prisoners were beng starved at Sing Sing. An inquiry was 
instituted, when it was ascertained that a liberal allowance of bread was 
given them, but less of beef. The diet was ordered to be changed ; less 
bread given, and more of animal food, when the complaint eeased. 

The man who leads a sedentary life requires a nourishing diet, but a 
" less stimulating one, than the laboring man : hence he should partake 
largely of vegetable or vegito-animal food. 

Nature kindly points out to man, the kinds of food best for him to par- 
take of, in the different regions of tne earth. Thus in the torrid regions, he 
has little appetite for animal food, but mostly repasts on the various pro- 
ductions of the earth. As we recede from the torrid towards the frozen 
regions, a more stimulating diet is required, and more of it. Thus the 
East Indians live on rice, fruit, &c. People of the temperate regions 
live both on animal and vegatable food : those of the frozen regions, 
mostly on animal food, as the Esquimaux, who live on train oil, the most 
gross of all kinds of food. 



FILING THE TEETH, 



Many persons, perhaps a majority of them, who have passed 
judgment in their own minds, on the practice of filing the teeth ? 
are opposed to the use of the file for the removal of caries in 
order to arrest the disease, thinking that the enamel, which 
is considered the natural shield of them, is removed by the 
operation ; and that the progress of the disease instead of being 
arrested, as is designed, is accelerated. And we are perfectly 
well aware of the circumstances which have given such cur- 
rency to this opinion. It is founded on the effects observed 
to result from the practice of the hundreds of operators, who 
have assumed to practice and to discharge the duties of a pro- 
fession, with which they were totally and culpably ignorant. 

True it is, that the teeth have too often been injured and 
abused, by the practice of indiscriminate filing. We have 
ourselves, with regret, too often witnessed the mischievous 
effects of such practice to deny it. Yet mark us, it is only 
when the use of the file is abused, that such consequences 
follow; as when teeth perfectly sound are filed asunder, 
mearly because their sides are in contact, and from that cir- 
cumstance may decay there; or, as when they are unskill- 
fully, awkwardly and irregularly filed ; or filed with a harsh 



Filing the Teeth. 129 

coarse file, which harrows up the bony structure of them, and 
they, being left in this state, unpolished, with a surface the best 
calculated possible for receiving and retaining foreign sub- 
stances, and for converting them into a foul, putrescent and 
acrimonious mass, of all things, the most favorable for the 
production of decay, do continue to decay ; or again, when 
they are filed for the removal of caries without accomplish- 
ing its entire removal, and are left in that exposed state* 
when instead of being imperfectly filed, they should have 
been perfectly prepared and plugged. But we trust that the 
abuse of any mode of practice, of any instrument, or of any 
principle, will not militate against its wholesome, judicious 
and approved application ; for if so, what instrument, inven- 
tion, system, or institution may not be discarded ? 

We have precisely the same ideas in relation to the use of 
the file, when it is injudiciously employed, as those have, 
who do not discriminate between its proper application and its 
abuse ; yet we are bold to affirm, that its employment in the 
hands of a skillful dentist, is a most efficient and sure means of 
removing and arresting incipient decay of the teeth; and as 
thus employed, is approved by the best dentists of the age. 

Some dentists are in the habit of separating the front teeth 
when perfectly sound, to prevent decay. We totally discard 
this practice. It is, as if a man should submit to take a 
nauseating dose of medicine, while in perfect health, merely 
because there was a liability to sickness with him, at some 
' future time. Preposterous ! leave health wiphy steed, and 
sound teeth unfiled. It is quite in time to tamper with the 
disease, and to dabble with the remedies, after the former has 
made its appearance : — ■" Sufficient unto the day, is the evil 
thereof." 

Finally, upon this subject, we would advise adherence to 
the following maxims : 

First — Never file a tooth, except disease justify the use of 
the file. 

Second — Consider filing a less evil than disease, and con- 
sequently to be preferred to it, 



130 Curative Treatment of Caries. 

Third — Never to file a tooth for the removal of caries, un- 
less by so doing, you can extirpate the disease effectually, and 
that too, without too great a sacrifice of the substance of the 
tooth, and at the same time, do not injure the chance for the 
operation of plugging, should circumstances subsequently re- 
quire it. 

Fourth — Do not file a tooth that can be better, and more 
effectually treated by plugging. 

After the observance of these rules, we would strenuously 
recommend the use of the file, as soon as the least appearance 
of caries can be detected ; indeed, then is the appropriate time 
to use it, even while the enamel is becoming discolored, rough 
and disorganized ; and the depth to which the file is to be 
carried, must be regulated strictly according to the above rules 
and the progress of the disease. In our humble opinion, the 
file is not generally used early enough, to obtain the greatest 
possible benefit from its use in arresting decay ; for we believe, 
that by a timely and judicious use of it, incipient decay of the 
front and of the small double teeth, may, in the greatest 
number of instances, be completely arrested. 

To the above directions for filing the teeth, there is however 
one exception; and that is when a tooth by being in contiguity 
with another that has been long carious, acquires by such ex- 
posure, a discoloration of its enamel on the side exposed, 
which may be either brown or of a very black hue, without 
any apparent derangement of its structure, which occurrence 
often happens. If, on examination of a tooth thus circum- 
stanced, its surface be found smooth and not broken in upon, 
no matter however much discolored it may be, it should not 
be filed ; indeed, no smooth or polished surface of a tooth 
should ever be filed : obtain and preserve a smooth surface, 
and you have nothing to apprehend from external decay, even 
though the enamel were removed ; indeed, this is the grand 
secret for the preservation of the teeth. 

It should be borne in mind, that the above rules and direc- 
tions for filing the teeth, are given where filing is to be prac- 



Filing the Teeth. 131 

ticed for the cure or arrest of incipient decay, and not for 
preparing the tooth for plugging. 

Reasons which justify us in recommending the use of the 
file, in the strongest manner, for the above purpose. 

First — The necessity for the separation of the teeth is indi- 
cated by the circumstances under which they are most liable 
to decay, which have been mentioned under the head of 
caries, and need not be repeated here. 

Second — If it be objected, that the enamel is cut away by 
the process, the objection is not valid, for the enamel will be 
found to be already destroyed, or so much disorganized as to 
be useless and even injurious to the subjacent portion of the 
tooth. 

Third — If again it be objected, that the bony portion of the 
tooth is exposed by the practice, the same remarks will apply 
as in the case above ; for its destruction will inevitably follow, 
if left to the ravages of the disease ; and with the most unfa- 
vorable result, the disease will be retarded ; and in most favor- 
able, completely arrested : and further, if even under the form- 
er supposition, they do go on to decay, so as subsequently to 
require plugging, before the disease is entirely arrested, yet, 
the operation is not futile, as it will only be anticipating what 
must be done preparatory to filling : hence, the chance of 
arresting the disease by filing, which is certainly very great, 
is an expenseless acquisition, can do no harm, and will, in a 
great number of instances, save a vast deal of trouble, vexa- 
tion, pain, and expense. 

Fourth — No objection ought to be made to the practice, on 
plea of disfigurement of the teeth, for if the operation be skill- 
fully performed, this result will not accompany or follow it. 

The following is an important position, as it shows what 
may be done for the arrest of incipient decay, by the judici- 
ous use of the file. 

The bone of well formed teeth, (or teeth whose structure is 
compact) exposed in a healthy mouth, the secretions of which 
are not vitiated or acrid, docs not decay, unless neglected, or in a 



132 Cttrative Treatment of Caries. 

situation ivhich favors the lodgement, retention and chemical 
action of foreign matter upon it. 

Proof — Savage nations file their front teeth into various 
shapes without inducing decay. Some negro nations on the 
western coast of Africa, and the Abyssinians file off the cor- 
ners of the incisores in both jaws, so as to make them point- 
ed, like the teeth of a saw. The Malay Indians file the incisores 
across their anterior surface, so as to give them the appearance 
of being fluted. These are convincing proofs that the mere 
filing of the teeth does not cause them to decay. 

The following cases, which we select from our notes, are 
positive proofs of our position, and show the great advantages 
to be derived from the judicious use of the file. 

CASE I. 

October, 1833, called on us for professional services, Mr. 
J. C. Forty years ago, the incisor teeth of the upper jaw 
being in a state of decay, were separated with a thin file, and 
the disease completely cut out from their inner surfaces, by 
the celebrated Joseph Fox, in London. They have not decay- 
ed in the least sicce, nor would an observer suspect that 
they had ever been operated upon. 

CASE IX. 

November, 1834, examined the mouth of Mr. W. two mo- 
lares, three bicuspides, one cuspidatus, and two incisores were 
filed ten years ago, for the cure of decay, by Mr. Cartwright, 
of London, the most celebrated dentist in Europe. More than 
one third of some of these teeth were filed away. The disease 
has not made any further progress since the operation. 

CASE III. 

November, 1834, plugged some teeth for Miss S. In 1827, 
the incisores, cuspidati and some of the bicuspides, being much 
decayed, were freely separated, and the disease cut away 



Filing the Tezth. 133 

from the inner surfaces of the incisores by the gentleman men- 
tioned in case II. This case is remarkable, for near one half 
the substance of the crowns of some of the teeth were cut 
away; notwithstanding, the disease was cured, and the teeth 
are still sound though much disfigured. 

CASE IV. 

September, 1835, rendered professional aid to Col. C. In 
1817, his front incisores of the upper jaw, were filed asunder 
for the cure of decay. They remain perfectly sound to this 
day. 

"The operation of plugging decayed teeth is the principal 
curative means in the hands of the dental surgeon. There are, 
however, other remedies of equal efficacy, if judiciously ap- 
plied. Such are filing, cutting, or the complete removal of 
the diseased parts of the bony structure by the file, or other 
suitable cutting instruments, so as to produce a regular and 
sound surface of the tooth, by which its health is preserved." 
—Koecker, page 407. 

" When the file is skillfully used, in the early stage of decay, 
it is one of the most valuable instruments in the boutique of 
the dentist, with which to arrest the further progress of the 
disease." — Snell, page 133. 

" The application of the file to the teeth, is considered by 
some persons, as one of the most injurious practices which 
can be performed ; they think that the decay of the tooth will 
certainly follow the removal of the least portion of the 
enamel. 

" The only plan that promises success in the cure of the 
decay of the front teeth, is to remove the carious part from 
that which is sound, with the expectation that the disease will 
thereby be stopped. This theory is justified by the success 
of the practice, whenever it is adopted, before the caries has 
reached the internal cavity." — Fox's Natural History of the 
Teeth, part II, page 143. 



134 Curative Treatment of Caries* 

In refering to the above quotation from Mr. Fox, it should 
be recollected that at the time he wrote, dental surgery was in 
its infant state, the operation of plugging little known, and 
not practiced with that success, which attends the operation 
of scientific dentists of the present day. 

" As soon as it is discovered, or even suspected that the 
incisor teeth begin to decay, they should be separated without 
loss of time, and the diseased parts cut away." — Gerbeaux r 
page 75. 

The opinions of dentists with respect to the use of the file 
differ very much, some extolling it, and others condemning it ; 
but the propriety of its use, under the circumstances we are 
treating of, cannot be doubted. It is certain, that the separa- 
tion of the teeth and the extirpation of the decay with cutting 
instruments will not arrest its progress in all cases, though it 
will retard it greatly, by preventing the lodgement and reten- 
tion of the causes of the disease, especially if care be taken 
to keep them clean. 

The secretions of the mouth, in some individuals possess, 
the property of acting chemically on the teeth; and the teeth 
of such persons will continue to decay in spite of art. Hence 
in the teeth of one person, separated for the cure of decay, the 
disease still progresses, while in another, ft is effectually ar- 
rested. 

That the progress of incipient decay is not always arrested 
by the use of filing and cutting instruments, is no argument 
against their employment ; for reasons before mentioned. 
(See page 130.) 

We have dwelt longer on this subject than we intended, 
but we wished to aduce facts and arguments enough to remove 
the strong and unfounded prejudices, which most persons have 
against the use of the file ; for we believe that wonders may 
be effected with this instrument, in the cure of incipient caries, 
if early and judiciously employed. 

The proper time for employing the file, in order that the 
greatest possible benefit may be derived to the patient by its 



Filing the Teeth. 135 

use ? is as soon as the teeth exhibit the least symptom of inci- 
pient decay. 

The symptoms which indicate the separation of the teeth 
are a rough, discolored or decomposing state of the enamel, 
marked by a brown or bluish spot, seen between the teeth, 
which cannot be removed by means of polishing materials. 

MANNER OF PERFORMING THE OPERATION. 

The dentist has a great variety of files for the above use ; 
some flat of various thicknesses, smooth on one or both sides, 
or rough on both ; others half round, oval or beveling, 

The front teeth should be separated with a flat file, never 
so thick as to disfigure them, and the separation should be 
effected by cutting most off from the tooth most injured. The 
file should not be caried quite to the gum, but a small projec- 
tion left on either tooth to prevent their aproximation, other- 
wise the object of separation will be defeated. If the file does 
not completely remove the decay, it should be extirpated with 
cutting instruments from the inner surfaces of the teeth. 

The bicuspides should be free!} 7 separated, the separation 
wider at their grinding surfaces than near the gum, and the 
projection must always be left on these teeth, or they will 
certainly approximate and aggravate the case : different kinds 
of files are used for this purpose. The above observations are 
equally applicable to the molares, under similar circum- 
stances. 

All the teeth are frequently attacked by decay on the ex- 
ternal sides near the gum, especially if neglected; a small 
round file, or cutting instruments are proper for its extirpa- 
tion, if deemed advisable. 

The above directions apply only to the proper method of 
using the file, to arrest the progress of incipient decay. When 
the disease has made further progress, it is a matter of consid- 
eration important to the patient, whether to file and cut away 
the decay, or fit the cavity and plug it ; for if the disease pro- 
gress still further, the teeth cannot be plugged afterwards, on 



136 Curative Treatment of Caries. 

account of the impossibility of making a cavity that will 
properly retain the plugging ; hence the teeth must be lost. 
As a general rule, it is safest and best to plug any tooth, in 
w r hich decay has so far progressed as to form a cavity sufficient 
to retain a plug. If the decay be spread over an extensive 
surface and be superfical, it should be filed away. Before pro- 
ceeding to either operation, the constitutional formation or 
structure of the teeth or their predisposition to decay, the 
state of the general system, of the digestive organs, and of the 
secretions of the mouth, should be duly taken into considera- 
tion. No precise or deffinite rules can be given, on account 
of the great variety of position, in which the teeth decay, the 
progress of the disease, and the circumstances under which it 
•^occurs. The operation must be left to the judgment of the 
judicious dentist. 

The filing of the teeth is a very nice operation, requires 
great mechanical tact and skill, as well as judgment. We 
have often seen the teeth horribly mangled, cut, notched and 
disfigured, by careless, ignorant or incompetent operators, 

"The method of using the file, in separating teeth, requires 
the most careful attention. I have frequently seen teeth, after 
they have been separated by some careless operator, that have 
made me feel ashamed of my profession. The file is often 
used in the most awkward and crooked manner.'' — Snell, 
page 136. 

Sometimes it is not necessary or advisable to separate de- 
caying teeth, but open them on the inner side and plug them. 
This however depends on circumstances. ■ The judicious den- 
tist must decide upon the proper treatment. 



SCURVY IN THE GUMS. 



Scurvy in the gums is a local inflammation of that part of 
the gum surrounding the necks of the teeth and their fangs, 
which, if not arrested, gradually extends to the sockets of the 
teeth. 

It is a disease of frequent occurrence, and often very de- 
plorable in its consequences, causing the loss of whole sets of 
beautiful and sound teeth, seriously affecting the constitution, 
and thereby producing much distress. 

The disease has been termed scurvy m the gums, from its 
having formerly been supposed to be analogous to the sea 
scurvy. It may be proper to mention for the satisfaction of 
persons of nice feelings, afflicted with this malady, that it is 
seldom if ever, that it has any analogy to that disease, as it 
falls under the observation of the dentist ; but, as the disease 
in question has long been known under its present appellation, 
it is best to retain it. 

There are two distinct speeies of this disease, though this 
division is not made by writers on the teeth. The first species 
is wholly the result of local causes, and may be properly 
termed simple. The second species depends both on constitu- 

6* 



138 Scurvy in the Gums. 

tional and local causes, and may be termed complicated. The 
treatment of the former is local, but the cure of the latter 
requires both constitutional and local treatment. 

These species have not been sufficiently distinguished by 
dental authors ; therefore, they generally lay to much stress 
upon constitutional causes ; for ninety cases in the hundred 
have little to do with the constitution, as far as the causes of 
the disease are concerned, these being mostly local, as neglect, 
tartar, dead roots, &c. 

Scurvy in the gums attacks persons of all ages and condi- 
tions,* though most frequently the hearty and robust, after the 
age of puberty. Old persons, who have been so lucky as 
not to have lost their teeth by decay, generally lose them by 
this disease, if they lose them at all; their teeth dropping out 
perfectly sound. It generally first attacks the incisores of the 
lower jaw, and the molares of the upper, because tartar is most 
apt to collect about these teeth, from the proximity of them to 
the salivary ducts. The disease gradually extends to the 
periosteum and sockets of the teeth, causing their gradual ab- 
sorption, and deposition of bony matter takes place at the bot- 
tom of the sockets, which gradually protrudes the teeth, till at 
length they drop out one after another, pefectly sound, till the 
patient is rendered edentiless. 



* " Persons of robust constitutions are much more liable to this affec- 
tion of the gums, than those of delicate habits; and it shows itself in its 
worst forms oftener after the age of thirty, than at an earlier period. 
The teeth of such persons are generally perfectly sound, or very little 
affected whh caries, though I have occasionally met with exceptions to 
this observation. 

"The lower classes are particularly subject to this affection; and not 
even those country people who enjoy uninterrupted good health, and the 
influence of the most salubrious atmosphere, and who have originally 
the most beautiful and healthy teeth, are altogether free from its attacks. 

"This disease seems to be confined to no particular climate, and is 
more or less prevalent in every part of the world : I have observed the 
inhabitants of the most apposite countries, the Russians, the Germans, 
the French, the Italians, the Spaniards, the Portuguese, the English, the 
Africans, the East and the West Indians, and the inhabitants of the 
United States, to be all more or less liable to it." — Koecfcer, pages 272 
and 273. 



Scurvy in the Gums. 139 

Symptoms. — Scurvy in the gums is often very insidious in 
its first attacks, and may continue and progress for a long time 
without being discovered by the patient. The local inflamma- 
tion, if it be not checked, goes on to suppuration, and purubent 
matter constantly oozes out from the gum surrounding the necks 
of the teeth, and mixing with the saliva, maybe discharged for 
a great length of time without detection. At length the gums 
become turgid, spongy and painful, bleeding on the slightest 
touch ; their color is generally very much depened, and of a 
purple hue. If the disease be now neglected, all the symp- 
toms gradually become agravated ; the irritation extends to the 
periosteum and sockets, occasioning them to participate in the 
disease, when they are gradually absorbed; the teeth grow 
loose, and continue to become more so ; a deposition of bony 
matter takes place at the bottom of the sockets, which pro- 
trudes the teeth, till they fall out of the mouth, one after an- 
other, often perfectly sound, untill the whole are lost. 

Causes.—- The causes of the simple species of the disease 
are local, though certain conditions of the system may pre- 
dispose to it: these are every kind of foreign matter collected 
about the teeth, especially tartar, which insinuates itself deeply 
between the gum and necks of the teeth, causing their separa- 
tion. Dead teeth and stumps are equally productive of this 
disease — improper operations upon the teeth — uncleanliness of 
the mouth, especially during illness or a febrile state of the 
system. 

The above are the exciting causes of that species of the 
disease, which we term simple: the exciting causes of the 
second species or the complicated, are the same ; but the remote 
or predisposing causes, are a particular state of the constitu- 
tion, as scrofulous or scorbutic taints of the system ; that stale 
of the system, which is induced by the profuse administration 
of mecurial medicines ; fevers, or diseases of the general sys- 
tem : a plathoric state of the system ; a peculiar irritability of 
the system, as is seen in those cases, where the disease attacks 
children, and that state of the system, which is induced by 



140 Scurvy in the Gums. 

debauchery, intemperance, &c. This species of the disease 
is more rapid in its course of destruction than the former, more 
distressing, and more difficult of cure. 

Dental writers, in our humble opinion, have laid too much 
importance on the remote or constitutional causes of the 
disease : in most cases, the constitution has little to do with 
it; for the healthy and mostrobust are said to be most subject 
to its ravages. Mr. Koecker says, that he has never seen the 
disease without a deposite of tartar upon the teeth, and that 
this has been its immediate cause. This opinion is further 
confirmed by the facts, that healthy persons, who keep their 
teeth free of the exciting causes of the disease, or free of tar- 
tar and every species of foreign matter, and whose teeth are 
sound, either naturally, or rendered so artificially, are never 
troubled by the disease in question, while those who neglect 
their teeth, are very liable to it; also, that people in the lower 
walks of life are the most subject to scurvy in the gum, be- 
cause they totally neglect their teeth. It is seldom that an 
aged pie- ' an is seen with teeth. We have never seen a single 
instance 01 this disease, in a healthy person, either in the 
higher or lower walks of life, that was not wholly produced 
by local causes. The disease being cured, in such cases, by 
local treatment 5 also shows that its causes are local. 

Scurvy in the gum, in its early stages, is seldom attended 
with much pal:"!, but as the disease advances, the pain is often 
considerable, and the constitutional irritation very great, 
though the patient or his medical attendant seldom attribute 
this excitement to its true cause ; the state of the mouth being 
considered as the effect of the constitutional derangement, in- 
stead of the cause of their derangement. 

Method of Cure.* — The indications of cure in the first or 

* " I have always succeeded in curing this disease in all its different 
stages by the mode of treatment, which I am now about to describe. 

"It consists, first, in checking the diseased action which has become 
habitual, and in producing a general kealthy disposition in the diseased 
parts, and those connected with them, by removing the actual causes; 
and, secondly, in preventing their occurrence. 



Scurvy in the Gums, 141 

simple species of scurvy in the gum, are the removal of the 
local causes of the disease. In the second or complicated 
species, the indications are the removal of both constitutional 
and local causes. 

All writers on the teeth agree, that scurvy in the gum may 
be easily cured by proper treatment, especially, in the early 
stages of the disease ; that to effect this object, requires 
prompt, decided and judicious treatment; that the practitioner 



" Every tooth which has lost its vitality, including all stumps, and all 
such teeth as from their irregular situation or direction excite a mechan- 
ical irritation, provided this irregularity cannot be remedied by filing, or 
by cutting away the irritating parts, should also be removed. 

"All operations should be performed with the greatest judgement and 
caution, and all teeth to be removed must be extracted at the same sitting, 
because it would either partly or altogether obviate the desired effects, if 
this particular operation were performed at different times. This advice 
i3 the result oi much experience, and should, if possible, be always 
adopted to ensure a successful cure. 

"The bleeding from the sockets should be encouraged by warm water 
taken into the mouth at short intervals, during the different operations, 
and continued for some time ; as its effects are of much importance. 

" A gentle astringent wash may be subsequently employed for several 
days. I have generally found the following simple preparations the 
most useful. 

" Take of clarified honey, three ounces, and of vinegar, one ounce. 
This, diluted in the proportion of three table spoonfuls to a pint of warm 
sage tea, or water, may be used frequently during the day. 

"Take of clarified honey and of the tincture of fcark, two ounces each. 
Mix and dilute as above. 

" Take of honey and of the tincture of myrrh, two ounces each. Mix 
and use as above. 

" Take of honey and of the tincture of rhatania, two ounces each. Mix 
and dilute as above. 

"Take of honey and of the tincture of catechu, once ounce each. Mix, 
dilute, and use as above. 

"In about ten or fourteen days after the removal of the teeth, the in- 
flammation considerably subsides, the gums assumes a more healthy ap- 
pearance, and the teeth become firm in their socket?. 

" The tartar should now be removed ; but there is often much diffi- 
culty in doing this well. It adheres so firmly to the necks or roots of the 
teeth, which are generally loose, and it is attached so closely to the alveo- 
lar processes, and is in many cases so covered by the edges of the gums, 
and so hidden between the teeth, that it is not without the utmost care 
that we are able to avoid irritating the gums and periosteum with the 
instruments employed. The operation, on this account, is to be perlormed 
with great caution and tenderness, in order to effect a perfect removal of 
the tartar without making the teeth still looser,"— Koecker. pages 288 
and 289. 



142 Scurvy in the Gums. 

must perfectly understand the disease he is about to treat, or 
he will only agravate it ; and that the fancy of the patient is 
not to govern his treatment. 

The first step recommended by dental writers of repute, in 
the treatment of this disease, is the extraction of the dead 
teeth and stumps, if there be any in the mouth ; and then, after 
a few days, they recommend the teeth to be scaled, or freed 
of tartar and other foreign matter. With all due respect to 
their opinions, we beg leave to differ from them somewhat in 
this matter. 

We always make it our rule, first to cleanse the teeth in the 
most perfect manner, if circumstances will permit. Some- 
times, however, when the necks of the teeth are exquisitely 
sensitive, (which is not often the case,) the operation may not 
be so perfectly performed, but great care should be taken to 
remove every particle of tartar adhering to the necks of the 
teeth, under the gums. This is an important point, and is 
one great reason why some operators fail in their attempts to 
cure the disease. 

The next step, is the removal of every dead tooth and stump, 
and every carious tooth which cannot be cured, from the 
mouth. This being performed, all the local causes are remov- 
ed and will be attended with the most beneficial resulls. An- 
other advantage gained is that the patient during this opera- 
tion, loses somewhat of the dread of the more formidable 
operation of extraction. If the teeth are not first scaled, before 
the extraction of the teeth, one grand cause of the disease 
still remains, and it cannot be cured till this is removed, con- 
sequently the cure is needlessly very much delayed. The 
local causes of the disease should always be removed at one 
sitting, if the patient can well bear it; then, after a few days, 
a very remarkable improvement will have taken place. 

During, and after the operations, the bleeding should be 
encouraged by rincing the mouth frequently with warm 
water. 

There is much diversity opinion among dentists, as to the 



Scnrvy in the Gums. 143 

after ireatment of the disease. Some recommend the gums 
to be often scarified, the mouth frequently rinced during 
the day, with strong stimulating tinctures or washes, and the 
teeth brushed morning and evening with a very stiff brush and 
an astringent tooth powder: others recommend mild washes 
and soft tooth brushes : each considers the treatment opposed to 
his views, as injurious. These opinions have arisen from the 
circumstance, that their authors have not discriminated the 
different slates or conditions of the disease ; whether the in- 
flammation be healthy or unhealthy. 

The proper treatment is clearly pointed out by the surgeon's 
treatment of ulcers : to healthy ones, he applies simple dres- 
sings, and leaves the rest to nature: to those that are unheal- 
thy and want action, he applies severe friction, stimulating or 
acrid washes or powders. So should scurvy in the gum be 
treated. After the removal of its causes, if the disease takes 
on a healthy action, as it generally does, mild washes, as those 
recommended by Mr. Koecker, and a soft tooth brush and a 
mildly astringent tooth powder, (see subject of tooth powders,) 
are all that are required or proper. On the other hand, when 
there continues unhealthy action, as indicated by swollen and 
spongy gums, bleeding easily, and of a livid color, which do not 
adhere about the necks of the teeth, scarifications, stimulating 
tinctures, a stiff brush, and a more powerful tooth powder are 
to be used. Under these circumstances the gums should be 
scarified, by passing a lancet freely between the teeth, to relieve 
the turged vessels of stagnant blood. Dr. Fitch recommends 
a decoction of white oak bark as an astringent wash. It is a 
very good one. A decoction 01 nutgalls is equalty good, and 
at the command of every one. Mr. Fox recommends, (and 
the practice is sanctioned by others,) a solution of the nitrate 
of silver to be applied to the gums, with a camel's hair pencil, 
when they continue of a livid color and spongy texture ; it is 
an excellent remedy. 

When the local causes of the disease have been removed, 



144 Scurvy in the Gums. 

great care should be taken to keep the teeth clean ; and on no 
account should the re-accumulation of tartar be permitted. A 
soft or hard tooth brush, and a mild or strong astringent in the 
tooth powder, should be used morning and evening, according 
to circumstances, also, mild or stimulating washes occasionally 
throughout the day. Mr. Snell recommended camphorated 
liniment to be applied to the diseased gums: we consider it to 
be one of the most useful remedies that can be used, and 
often prescribe it : it can be applied with a camel's hair pen- 
cil or with the finger. If the teeth be brushed after every 
meal with a soft brush and castile soap, the cure will be faci- 
litated ; it will also render the mouth delightfully sweet and 
clean. 

In the complicated species of scurvy in the gum, it is neces- 
sary to administer internal medicines for the removal of those 
states of the system, enumerated as the predisposing causes 
of the disease, in conjunction with the local treatment.* 



* In order ro show the effect which this disease occasionally has upon 
the general system, and also the proper treatment of it, we mention two 
or three cases. The following is from Mr. Koecker : 

" Mr. J -, a gentleman of great respeccability, a native of this 

country, but for many years a resident of Smyrna, aged about thirty- 
nine, had suffered upwards of ten years from this distressing malady, 
attending by all its torturing symptoms, in a most unparralleled man- 
ner. His whole constitution; but particularly the glandular system, was 
so much affected as to produce swellings and indurations in the most 
distant parts, accompanied with great pain and inconvenience; but its 
effects on his head were frequently agonizing ; indeed, he assured me, 
that so great were Ins sufferings, that he had been driven so far to de- 
spair, as to implore Heaven to relieve him by putting an end to his mis- 
erable existence. He repea'edly applied for the best medical and surgi- 
cal advice that the country could afford; but the real causes of his 
sufferings were not detected ; and such was the character of this disorder, 
that it baffled every exertion and all the remedies which were applied 
for many years. At length the effects of a sea voyage and a visit to his 
native country were proposed, and at the same time a trial of such re- 
medial measures as he might be able to command in England. 

11 Immediately on his arrival in London, this patient consulted Mr. 
Lawrence. This sagacious and disinterested surgeon soon suspected his 
teeth to be the chief cause of his malady, and recommended him to have 
my advice without delay, and to submit to any treatment 1 should deem 
necessary and proper. 

" On examining the gentleman's mouth I found his gums and all his 



Scurvy in the Gums* 145 

Reflections* — It is seen that scurvy in the gum is generally 
produced by local causes, often, very often, wholly the effect 
of neglect, and that it is a disease easily cured. 



alveolar processes more or less diseased. His double teeth, however, had 
most especially suffered : and so considerable a part of their sockets was 
destroyed, that their preservation was rendered aJ together impossible. I 
therefore proposed their immediate removal ; and, although the gentle- 
man was excedingly nervous, he acceded to my proposed plan of cure 
without the least hesitation. 

"February 14th, 1826. Thirteen roots and teeth were extracted, and 
the mouth was subsequently cleansed with a gentle stimulant lotion 
every hour or two in the course of the clay. 

"February 21st. The remaining front teeth of the upper and under 
jaw were carefully scaled as far as the diseased state of their gums 
would allow of, and the patient provided with the means of preventing 
the re-accumulation of tartar. He was reques.ed to continue the use cf 
the louon. 

" February 28th. The above operation was repeated, and cleanliness 
particularly recommended. 

"'March 7th. The same operation was completed, and a perfect re- 
moval of the tartar was accomplished : the patient was also directed to 
proceed as before. 

" Thus by the judicious management of the case by Mr. Lawrence, 
and the above treatment, the patient was now, in less than one month, 
restored to perfect constitutional health. Kis mouth was rapidly recov- 
ering from a disease, probably of more than fifteen years standing; and 
the most important of his teeth were saved from total destruction, and 
permanently preserved." 

October, 1832. Consulted by Mrs. , she stated that her teeth 

and mouth were in a wretched condition — that she had suffered infinitely 
from tooth ache, pain in her jaws, face and temples, and was still suffer- 
ing as much — that her health was much impaired — that the medicines 
prescribed for her proved of little advantage — that she had spent some 
months on the sea shore for the benefit of sea air, battling, &c. ; but that 
her health had not improved so much as she had been lead to expect by 
her physician— that she had often thought her teeth to be the cause 
of her sufferings, but that she had never been able to make up her mind 
to have any thing done to them, &c. 

On examining her mouth, we found that every molar tooth was so 
much decayed that nothing could be done for their preservation, the 
crowns of some of them being entirely destroyed, the dead roots remain- 
ing. The four incisores and the four bicuspides of the upper jew, were 
all more or less decayed. The eye teeth were sound. The posterior 
bicuspides of the lower jaw were also decaying. Her gums, as she 
truly said, were in a wretched condition, much swollen, loose and spongy 
and bleeding on the slightest touch, and on pressing them with the finger, 
puriform and bloody matter issued from about the necks of the teeth, 
which were incrusted with large quantities of tartar: she had not been 
able to use her brush for a long time on account of the soreness cf the 
gums. Her breath was exceedingly offensive. 



146 Scurvy in the Gums. 

When we reflect how many beautiful and sound teeth are 
lost by this disease, and how much local and constitutional 



We gave it as our opinion, that her il] health was principally caused 
by the state of her mouth, and explained to her the reasons on which 
this opinion was founded. She readily consented to have any operations 
performed which might be deemed proper. 

To be brief : the tartar and foreign matter were first removed from her 
teeth in the most perfect manner : this was as much as she could bear to 
have done the first day ; on the second day the dead teeth and roots were 
removed from the upper jaw; and on the third from the lower, making 
in all, twelve. She was furnished with the necessary washes, brushes 
and powders, with proper directions. Within three weeks from this time, 
the disease in the gums and sockets was completely cured, and her 
general health improving. The carious teeth were now plugged, — the 
nerves of three of which had been destroyed by means of arsenic. Two 
years afterwards, we saw this lady enjoying good health and her mouth 
perfectly well. 

Reflections. — Is it probable that diseased teeth, gums and sockets do 
ever seriously affect the general system? 

The sympathy existing between the teeth and their relative parts, and 
between these and the general system is very great, in consequence of 
which, (see the reasons pages 17, the intimate connexion existing be- 
tween the dental and facial nerves, and those of the general system, by 
means of the great sympathetic nerve,) when disease is going on in the 
mouth, it becomes sympathetically affected in a greater degree, than it 
does from disease of equal extent in any other part, where vital organs 
are not engaged. Every one is familiar with the violent constitutional 
derangement which so frequently results from tooth ache, ague in the 
face or gum-biles ; we have seen many cases where persons have been 
confined a week or ten days by these affections. 

Again, the imperfect manner in which the food is masticated when 
the mouth is very much diseased, and the morbid matter which is mixed 
with the food and carried to the stomach, cannot but have a tendency to 
derange the functions of digestion. For further opinions on this subject, 
see "effects of diseased teeth, gums and sockets, upon the general system." 

The two following cases, will show the usual causes of scurvy in the 
gum, and its effects, the necessity of thorough operation for its cure, and 
the impropriety of patients dictating the plan of treatment. 

September, 1833. Mr. V — , a gentleman of a robust and healthy 

constitution, laboring under this disease consulted us, stating that he had 
long been suffering under an affection of the gums, had neg'ected 
so long to apply for assistance, that he feared little could be done for 
him. 

On examining his mouth, we found the disease had made sad ravages. 
The teeth were much incrusted with tartar, especially the incisores of 
the lower, and the molares of the upper jaw. The gum and alveoli of 
the incisores and bicusp ides of the upper jaw were considerably diseased, 
and so much absorbed that these teeth appeared much longer than 
natural. The gum and sockets had fallen away so much from the four 
anterior molar teeth of the same jaw, and these teeth had so much pro- 



Scurvy in the Gums. 147 

suffering it often occasions, we cannot but regret that a disease 
so perfectly under our control, should be so often permitted to 
make such sad inroads upon our health, our personal appear- 
ance, and our comfort, as though the thousand ills, to which 
man is heir, and which he cannot foresee or prevent, were 
not enough to consummate his misfortunes. 

Notwithstanding, there are many who neglect to pay atten- 
tion to the disease, either in the hope of spontaneous relief or 
from the fear of paiuful operations, till compelled to seek relief, 
when too often the disease has made such progress tfiat many 
teeth are inevitably lost, and others much injured and more lia- 
ble to future disease. It is in the power of every healthy per- 
son, to keep his mouth free of the local causes of the disease, 
which are also, the grand causes of external caries of the 



truded, that nothing could preserve them. The two anterior molares of 
the lower jaw had been extracted, and the crowns of the second were 
decayed away. The bicuspides and canine teeth were sound and firm in 
their sockets, but the incisor teeth were very much protruded and quite 
loose. We gave it as our opinion, that this disease could be perfectly 
cured, but that it would be necessary to extract the four incisores, the 
roots of the decayed molar teeth ffi the lower jaw, and the four molar 
teeth of the upper jaw. He would not allow the incisores to be removed, 
but would submit to any other operations that might be deemed neces- 
sary. His teeth were scaled in the most perfect manner, and the molar 
teeth and stumps extracted, and the gums scarified between all the 
other teeth, to relieve the turged vessels and induce a new action. Our 
patient was furnished with an astringent lotion, (decoction of oak bark,) 
and tooth powder. In a few days he returned when we found a great 
improvement in the state of his mouth. The gums were again scarified, 
though not so extensively as before, and he continued the use of the 
lotion. In four weeks from the time of the first operation, every part of 
the mouth, except the incisor teeth of the lower jaw, was perfectly 
restored to health ; but here the disease continued in spite of every effort 
till the teeth were removed. 

June, 1832, Consulted by Mrs. , found her teeth covered with 

large quantities of tartar — the gums much diseased and so sore that she 
had not been able to use her brush for a long time. The crowns of most of 
the molares had decayed away even with the gums. She had suffered 
very much. Her teeth were carefully cleansed, every dead tooth removed, 
which soon restored her gums to health. The incisores of the upper jaw 
being much decayed, also three bicuspides, were plugged. She has not 
been troubled with her teeth since these operations. 



148 Scurvy in the Gums. 

teeth ; and he who does this, consults his health and comfort, 
as well as his purse. It is much better to prevent disease of 
any kind, if this can be done, than to cure it. It is also vastly 
better and easier to cure disease in it3 early, than in its ad- 
vanced stages* 



SALIVARY CALCULUS 



OR 



TARTAR OF THE TEETH. 



Tartar of the teeth is an accumulation of calcarious or 
earthy matter about the teeth : it is principally composed of 
phosphate of lime and animal matter, and is secreted with the 
saliva, or, it rather enters into the composition of this fluid, 
and is deposited in layers about the teeth i it often collects 
in great quantities if means be not used to prevent its accu- 
mulation, so much so, that it occasionally incrusts the teeth, 
especially if a tender tooth, prevent mastication on one 
side of the mouth. There are cases on record of this sub- 
stance having collected in such quantities, as to occasion pro- 
minences in the cheek like tumors : we have seen two or three 
like cases: we have also seen a piece of tartar half the size of 
a hen's egg. 

Tartar is most apt to collect on the external side of the mo- 
lares of the upper jaw, and on the inner side of the incisores 
of the lower, because the salivary ducts enter the mouth at 



150 Tartar of the Teeth. 

these points : it occasionally obstructs these ducts, so as to 
produce ranula, or a swelling caused by the accumulation of 
the saliva. 

Almost every person is subject to the formation of tartar, in 
a greater or less degree : in some, this disposition is so great 
that the teeth cannot be kept clean and free of it, without the 
frequent use of a proper tooth brush and dentifrice ; in others 
it is so small that little attention is required. 

The formation of tartar is much influenced by the state of 
the system. During the continuance of any febrile disease, 
the secretory organs of the whole body are deranged and do 
not perform their functions as in health ; the mouth and teeth 
often become loaded with a thick fur, or inspissated mucus of 
a yellowish or brown color ; the mouth tastes extremely disa- 
greeable to the patient himself, and his breath is very offensive 
to those in attendance : under such circumstances, nothing is 
more delightful to the patient than to have the mouth cleansed : 
some physicians recommend solutions of the mineral acids for 
this purpose ; but the use of such remedies must prove very 
injurious to the teeth, and therefore should never be used. 

When the tartar is first secreted, it is quite soft like slime, 
and may now easily be removed with a tooth brush and pow- 
der, but if neglected, it soon becomes concrete and hard. Most 
persons, if they will observe when they rise in the morning 
after sleep, will find their teeth more or less covered with a 
viscid yellowish mucus ; this is tartar, which, if not removed by 
the daily use of the tooth brush, will adhere about those parts 
of them, not subject to friction during mastication, and in time 
collect in large quantities. 

Tartar is of a yellowish or buff color, especially that 
which collects about the molares ; that which is seen about 
the incisores is often of a brown color. The deposition of this 
substance cannot be prevented by any medicines, as it depends 
upon the state of the saliva ; but its accumulation may gene- 
rally be very easily prevented by carefully brushing and 
washing the teeth every morning. 



Tartar of the Teeth, 151 



EFFECTS OF TARTAR.* 



Tartar is one of the most injurious agents to which the 
teeth are exposed ; it is also the grand cause of the disease in 
the gums and sockets, called scurvy in the gum. Mr. Koeck- 



* " There are parts of the teeth which lie out of the way of friction, 
viz, the angles made by two teeth, and the small indentations made be- 
tween the teeth and the gum. 

"Into these places the juices of the mouth are forced, and there stag- 
nate and deposite a quantity of calcarious matter, which is dissolved in 
them, and which is separated from them by exposure, giving the teeth 
the appearance of being stained or dirty. If art be not now used, the 
incrustation increasing covers more and more the teeth. When it has 
increased so much as to touch the gum, (which very soon happens, espe- 
cially at the angles between the teeth,) it produces ulceration of that part, 
and a train of bad consequences. Often the gums receding from this 
matter, become very tender and subject to hemmorrhage. 

" The sockets frequently take part with the gums, ulcerate and become 
absorbed; so that the teeth are left without support and drop out." — ■ 
Hunter , page 192. 

"Tartar is one of the most frequent causes of the diseases of the teeth. 
It acts directly chemically in the destruction of them ; whilst, by its me- 
chanical and irritating influence, it is rendered indirectly more destruc- 
tive to them, it being one of the most powerful causes Gf the diseases in 
the gums, periosteum, and the alveoli. 

"I have seen instances in which whole sets of teeth, of which the 
greatest number were perfectly sound, drop out one after another in 
consequence of the ravages produced upon the surrounding parts by the 
incrustation of tartar. It is in fact from this ca.use that the most healthy 
people of the poorer and middle classes, even those who enjoy the 
healthy and salubrious atmosphere of the country not excepted, almost 
universally lose their teeth at that period of age, when the digestive 
organs begin to be less regular in their functions." — Koecker, page 65. 

" Nothing is more destructive to the health of the teeth than tartar. 
When any considerable quantity of this substance is suffered to collect 
about the teeth, the gums become inflamed and swollen, often producing 
absorption of the sockets and the premature loss of the teeth." — Snell, 
page 180. 

u Tartar is very injurious and destructive to the teeth $ as the accumu- 
lation increases, its effects keep pace with it ; the gums become exceed- 
ingly painful, so as to render the ordinary operation of brushing the teeth 
almost impracticable, and this inducing a neglect of the common means 
of preventing its accumulation, it becomes the unavoidable cause of its 
continued increase. Absorption of the gum and alveolar processes is the 
next consequence which gradually goes on until the teeth, loosing their 
support become loose, and at length fall our." — Thomas Dell, page 196. 

" Next to caries, nothing is more destructive to the health of the mouth 
than tartar."— Fitch on the Teeth, page 377. 



152 Tartar of the Teeth. 

er says, :h. t tartar acts chemically on the teeth : in conjunc- 
tion with o her agents, it most certainly does so, as is clearly 
proved by the facts, that teeth which have been coated with 
it, for a length of time, are very generally found rough, dis- 
colored and decomposing, and that external decay of the molar 
teeth generally commences near the gum, where the enamel 
is thinest and tartar most apt to collect. 

This substance is very productive of scurvy in the gum, by 
collecting about the necks of the teeth, and by insinuating 
itself deeply between the gum and sockets, causing inflamma- 
tion and suppuration which gradually extends to the sockets. 
Tartar seen about the front teeth is exceeding offensive to a 
person of nice feelings ; it is also one principal cause of a 
fetid breath, than which nothing is more disgusting, 

OF THE MEANS TO BE USED TO KEEP THE TEETH 
FREE ; OE TARTAR. 

It is in the power of almost every person to keep his teetb 
perfectly free of this substance, and it is to be wholly done by 
mechanical means, which will be fully treated of under the 
head of brushing the teeth, tooth powders, &c. Where there 
is a great disposition to the formation of tartar, some dentists 
recommend chemical agents for this purpose, as acids or alkalis, 
but the former are highly improper, as an acid which will act 
upon the tartar, will also act upon the teeth, for both are prin- 
cipally composed of the same materials, namely, the phos- 
phate of lime : the latter are of little use, as they can only 
act on the mucus or animal matter, which enters the compo- 
sition of the tartar. Acids are ruinous to the teeth, not only 
by dissolving the enamel, but by making the surface of them 
rough, a state the most favorable possible for the collection 
and retention of foreign matter, and its action on their substance 
so as to produce decay. 



Tartar of ths Teeth. gg*| 153 

OF THE OPERATION FOR THE REMOVAL OF TARTAR 
TERMED SCALING THE TEETH. 

When tartar has collected upon the teeth in any quantity, 
the instruments termed scaling instruments are the only proper 
means for effecting its removal. The operation is to be perform- 
ed in a very careful manner, and great pains taken to effect 
the removal of every particle of foreign matter, or it will form 
a nucleus, about which the tartar will again immediately col- 
lect. Where the teeth are covered with large quantities of 
tartar, many dentists recommend its removal, to be effected at 
different times : we never saw an instance in which it was 
not advisable and proper to remove the whole at one sitting. 
Some dentists are in the habit of using acids, previously to 
the operation of scaling, in order to soften the tartar. We do 
not think this practice judicious. There is no difficulty in 
removing the tartar with proper instruments. Some empirics 
use acids after the operation of scaling, and term it " whiten- 
ing the teeth :" this practice makes the teeth beautifully white, 
therefore, people are pleased, and some think the dentist does 
not do his duty or serve them as well as another, if he does 
not " whiten the teeth." This practice cannot be too strongly 
deprecated, for the acid produces the effect, by decomposing 
a portion of the enamel, and leaves the teeth very rough, 
which if left in this state, will soon become more black and 
filthy than they were before. Some persons are in the habit of 
having their teeth regularly scaled or cleaned once or twice a 
year: this practice must prove injurious. It is much better to 
keep the teeth in such a state, that they will not require scaling 
at all ; for it is in the power of every one, (if we except a few 
rare cases where the teeth are irregular,) to keep his teeth 
perfectly clear, if he furnish himself with the proper appa- 
ratus.* 



* C( 



"In the course of my practice, I have seldom been obliged to repeat 
an instrumental cleaning of the teeth, after once having restored them to 



154 Tartar of the Teeth. 



POLISHING THE TEETH. 



The grand secret of preventing external decay, as it so fre- 
quently attacks the teeth on their sides near the gums, (not on 
the contiguous surfaces,) consists in keeping the teeth highly 
polished. The importance of this fact to the lovers of sound teeth 
is manifested by these circumstances. The teeth never decay 
on the inside, (we should rather say very seldom, for we have 
seen a few rare instances,) while they often decay on the out 
side. Why is this ? are the teeth any better protected at this 
point ? is the enamel thicker ? No ; the reason is that the motion 
of the tongue keeps the sides of the teeth with which it comes 
in contact clean, and of their natural high polish ; it prevents 
that stagnation of acid fluids, and collection of putrescent and 
corrosive matter which act on the teeth on the outside. Again, 
the teeth of those persons who keep them perfectly clean and 
highly polished, as rarely decay on the outside as on the 
inside, while the teeth of those who neglect them are very apt 
to decay on the out side. Can there be stronger facts to 
prove the importance of keeping the teeth highly polished 1 

After the teeth have been scaled, they should always be 
nicely polished ; also when the teeth are at all rough. Few 
persons, very few indeed, keep their teeth so free of foreign 
matter, and so highly polished as they ought, if they would 
prevent decay and consult their welfare, for in proportion to 
the height of this polish, their aptitude to become rough, dis- 



perfect health, except in some particular cases, or where neglect of the 
patient to follow my directions, has made it unavoidable. I have always 
considered it my duty to keep my patients supplied with the necessary 
means for keeping their teeth clean. 

11 The practice so frequently adopted in this and other countries, of 
having the teeth regularly cleaned by a dentist, and irritated by incom- 
petent operations every six or twelve months, although profitable to him 
is about as ridiculous and mischievous as the exploded one of taking a 
strong dose of medicine once a month, for the purpose of preserving the 
digestive organs in a healthy state; a practice so common a long time 
ago, that its general adoption gave rise to the common salutation, ' Avez 
vous bien purge."— Koecker ) page 182. 



Tartar of the Teeth. ggg 155 

colored, or covered with tartar is diminished. If the teeth 
have a perfectly smooth surface, they can easily be kept clean 
with a brush and water : if they be rough, this can hardly be 
done with the addition of a tooth powder. 

METHOD OF POLISHING. 

The teeth can be best and most expeditiously polished, with 
proper tooth brushes, bits of soft pine wood, pumice stone very 
finely pulverized, and crocus. The teeth may first be thorough- 
ly but carefully brushed with the pumice stone; then with 
the bits of wood, they are to be rubbed wherever they are 
rough, especially near the gums and between the teeth, first 
with the pumice stone and then with the crocus, which will 
give them a high and beautiful polish. The front teeth may 
be polished on their contiguous sides, by running silk thread 
with pumice stone between them. This last operation is 
highly useful for the prevention of decay, for whenever a tooth 
is about to be attacked by external decay, the enamel is always 
found rough, which favors the lodgement of foreign matter; 
if it be now polished, this disposition is removed. Hence also, 
the importance of polishing the sides of teeth after they have 
been filed. Whenever the front teeth are the least black or 
discolored, the discoloration should be removed, if possible, by 
the means just mentioned, and if this cannot be done, no time 
should be lost in having i ecourse to the file, for their separation. 

There is one state of the teeth, requiring polishing which 
we wish especially to mention, as it is exceedingly injurious 
to the teeth, and conducive to their decay. 

The teeth of young persons are very often seen covered 
with a brown or greenish yellow scurf, especially the front 
teeth ; this also occasionally happens to persons more advanced 
in life. If the teeth of such persons be closely examined, the 
enamel will be found very rough, and if it could be micro- 
scopically examined, ten thousand little holes or rather depres- 
sions would be observed in it, in which, the foreign matter or 



156 Dead Teeth and Roots. 

scurf is contained. This state of the teeth is exceedingly in- 
jurious to their health, and beauty, and should not be neglect- 
ed. The foreign matter cannot be brushed away, but instru- 
ments will be required for its removal. The teeth should 
then be polished in the nicest manner. 

Many persons believe, or rather are very apprehensive, that 
scaling the teeth may prove injurious to them, thinking that 
a portion of the enamel is removed by the operation. Scaling 
the teeth, when improperly performed, (as when the foreign 
matter is carelessly or imperfectly removed, or acids used to 
effect this purpose, or to " whiten the teeth,") is certainly in- 
jurious to them ; but he who puts himself under the care of a 
scientific dentist has nothing to fear; he will not remove a 
particle of the enamel which is not disorganized or destroyed. 

" All acids, gritty powders, and injudicious methods of 
scaling the teeth, are prejudicial : but simply scaling the teeth, 
that is, cleaning them of stony concretions which frequently 
collect about their necks, while nothing is scraped off but that 
adventitious substance, is proper and useful.-" — Hunter, 
page 192. 

"Scaling the teeth is one of the most useful operations in 
dental surgery."— Fitch on the Teeth, page 373. 



DEAD TEETH AND ROOTS. 

These foreign bodies are extremely productive of the dis- 
eases of the teeth, gums, and sockets, by the irritation which 
they occasion : they are the cause of gum-biles, and are pro- 
ductive of malignant diseases of the jaw-bones: they are also 
apt to render the breath offensive. Dead teeth and roots exert 
such a noxious tendency, that we would urge every individual 
possessing them, who values his remaining teeth, his comfort 
and health, to have them extracted : they can generally be 



Gum- Biles. 157 

easily removed ; much more .so, than living teeth or fangs, for 
the connexion existing between them and the periosteum is 
destroyed, so that they are only held in their sockets mechani- 
cally, and nature often has thrown them out so much, that 
they merely adhere to the gum. 

" Dead teeth and stumps, by the constant irritation and 
morbid action which they occasion, may be considered as the 
principal cause of many nervous and rheumatic affections of 
an alarming nature, accompanied with much pain ; namely, 
disorders of the organs of sense, as of the eyes and ears ; 
diseases of the brain, face and more distant parts, under the 
forms of tic douloureux, convulsions, epilepsy, hysteric hypo- 
chondriasis, dyspepsia, &,c."-—Koecker 1 page 258. 

" Dead teeth and roots are generally the cause of alveolar 
abcesses or gum-blies. They should always be extracted."— 
Thomas Bell, page 216. 



GUM-BILES. 



Gum-biles are the result of inflammation in the sockets of 
the teeth, or rather of the periosteum or membrane which 
lines the sockets, and surrounds the fangs, terminating in sup- 
puration ; and this inflammation is caused by the irritation 
of dead teeth and fangs, which have become foreign and ex- 
traneous bodies, by a total destruction of the vascular and 
vital connexion existing between them and the periosteum. 

Nature, ever watchful to guard herself against disease, en- 
deavors to rid herself of these noxious bodies, and she slowly 
performs this process, by causing an absorption of the sockets, 



158 Gum-Biles. 

and deposition of bony matter at the bottom of them, which 
gradually protrudes the cause of irritation. During this effort, 
there is always a chronic inflammation in the parts, which, by 
cold and other causes, often becomes lighted up into active 
inflammation, which terminates in suppuration, and gum-biles 
are the consequence. 

Inflammation never attacks the socket of a healthy fang, so 
as to produce gum-biles, unless caused by some mechanical 
violence. The irritation of the file, in preparing stumps for 
the substitution of artificial teeth, sometimes occasion gum- 
biles, especially if the stumps are bad, or the patient careless, 
and expose himself to cold and wet. We have occasionally 
seen them result from the irritation of a plug upon the naked 
nerve of a tooth, causing inflammation, which, if the plug 
be not removed, extends to the socket. 

Gum-biles are of frequent occurrence, and when neglected, 
often very serious in their consequences, either bursting exter- 
nally, so as to produce an ugly ulcer, which, in healing, 
leaves an unseemly cicatrix behind, that disfigures the indi- 
vidual for life, or, causing the death of a greater or less por- 
tion of the jaw-bone, which exfoliates and produces much mis- 
chief. 

Gum-biles generally burst in the gum, nearly opposite to 
the point where the dead fang is situated, which has caused 
the malady, and sometimes after the matter has been evacuat- 
ed, the opening contracts, but it is seldom that the gum-bile 
disappears, and a small fistulous opening remains, at which 
matter continues to be discharged ; every time the individual 
takes cold, a recurrence of the inflammation, and a re-accu- 
mulation of matter are sure to follow : hence, the only effectu- 
al cure of them, is the removal of the cause, or the extraction 
of the dead teeth or fangs, as soon as the inflammation shall 
subside, so as to render the operation advisable: often, when 
the dead teeth are loose, it is better to remove them at once ; at 
all events, as soon as the soft feeling of the swollen parts, and 
the sensation of throbbing pain indicate the formation of mat- 



Gwn-Biles. 159 

ter, a puncture should be made with a lancet, so as to suffer 
it to escape and prevent a more extensive effusion.* 



* " When the inflammation caused by a dead tooth is very great, we 
should be particularly careful to guard against its effects. The forma- 
tion of matter is often so considerable, as to produce an abcess of no 
small extent. In some cases, the matter is contained within a cavity, 
extending through the length of one side of the jaw. Those which 
produce the most distressing symptoms are the wisdom teeth of the 
lower jaw ; when inflammation extends from either of these teeth to the 
contiguous pans, the swelling is speedily diffused over the whole cheek, 
so as to close the eye, and cause a considerable hardness of the upper 
part of the neck near the angle of the jaw. The muscles of the jaw 
are also affected by adhesive inflammation, and they become so rigid, 
that it is with great difficulty the mouth can be opened. 

" These cases require the utmost attention, for a large abcess is usually 
formed, which, if left to itself bursts externally ; the ulceration extend- 
ing through the substance of the cheek, there producing a most trouble- 
some sore, which when healed, leaves a deforming scar. To prevent 
these sad consequences, when the matter is formed, a free opening should 
be made on the inner side of the cheek, into the softest part of the tumor.'' 
—■Fox's Natural History of the Teeth, pari II, pcge 70. 

When gum-biles burst externally, they generally make their appearance 
in the middle of the cheek, if the abcess be situated in the upper jaw, but 
if in the lower, the opening is generally seen a little below the jaw or at 
its angle. These abcesses are rarely healed till the cause is removed : 
we have know dressings to be applied to them for months without any 
benefit whatever : we have even known them to be treated as scrofulous. 
Mr. Fox mentions a case, wherein lotions and dressings were employ- 
ed for two years without advantage ; therefore, it is folly to attempt a 
cure, without first removing the cause of the mischief. 

Whenever a person has a swelled face from a gum-bile, great care should 
be taken that the abcess does not burst externally ; if there be any dan- 
ger of this, it should be early opened on the inside of the mouth. 

When gum-Mies are neglected, they sometimes produce the death and 
exfoliation of a greater or less portion of the jaw bones, which occasions 
much mischief. Mr. Fox mentions three such cases. Mr. Koecker and Mr. 
Bell, state that they have seen many cases of exfoliation of portions of 
the jaw bones, caused by neglected gum-biles. Other authors make simi- 
lar statements. Like cases have fallen under our own observation, in one 
of which, four sound teeth were lost, and in another, two. Hence, gum- 
biles should never be neglected, for fear of the consequences which often 
result from them. 



160 A Fetid Breath. 



OF A FETID BREATH. 

la healthy persons, a fetid breath, (with which we so often 
meet, and which is so offensive to the person of nice feelings,) 
is generally caused by the state of the mouth, as tartar and 
other foreign matter, diseased teeth, gums and sockets, and 
the decomposition of food lodged in the interstices of the teeth. 
Decomposing artificial teeth render the breath exceedingly 
offensive.* 

That the above observations are correct, and that an offen- 
sive breath does not depend on the lungs or stomacb, as is too 
often supposed, is proved by the following circumstances. 

Healthy infants have a sweet breath, and so do old per- 
sons who have lost all their teeth. The breath of persons who 
have sound teeth and keep them clean is seldom offensive : 
on the contrary, the breath of those, whose teeth and mouth 
are diseased, or who neglect them, is generally more or les 
fetid. Let a person who has a fetid breath, cleanse his mouth 
with a detergent wash, or breathe through his nose, and it is 
no longer offensive. 



* " Fetid breath is entirely occasioned by the state of the mouth." — 
S. S. Parmty's lectures, page 24. 

" When the disgusting effects of a foul mouth are considered, it would 
appear impossible, that any persuasion could be necessary, to induce 
persons to obviate so great a nuisance, even on their own account; or, if 
they are too debased to procure their own comfort and cleanliness, at the 
expense of a very little care and trouble, they surely have no rigkt to 
shock the senses of others, who possess more propriety and delicacy of 
feelings than themselves. Fet^o it is, and the sight and the smell are 
alike constantly outraged by the filthinesis of people, who seem to ob- 
trude their faces the closer in proportion to the disgust which they occa- 
sion." — Thomas Bell, page 192. 

Bruserade once said of a young lady whom he heard sing, and who 
had a strong breath, " that is a charming voice ; the words are very fine, 
but the air is not agreeable." — Gerbeaux, page 33. 

"A foul mouth, according to the testimony of Leuw T enhoeck, is the 
habitation of numerous animalculee ; his communications on this subject 
are very curious, and are published in the philosophical transactions ; 
Vol. 16, No. 159, page 563, and Vol. 17, No. 197, page 646."— Murphy, 
page 69. 



• Cleanliness of the Mouth. 161 

Consumptive persons, those having a febrile state of the 
system, and those whose digestive functions are deranged, or 
whose bowels are habitually constipated, will often have an 
offensive breath which does not depend upon the state of the 
mouth. 

Remedies. — The only effectual remedy for this state of the 
breath, is the complete removal of its causes ; if this can not 
be done, it may be disguised by the frequent use of almost 
any aromatic, or aromatic tinctures or washes : of these 
last, the tincture of myrrh, largely diluted with water, can be 
used with the greatest advantage. The proper manner of 
using the myrrh is to take a sufficient quantity of cold water 
in a tumbler, then add enough of the tincture to cloud it, or 
to make it agreeably strong. Chlorine, from its well known 
property of destroying animal or vegetable effluvia, has been 
strongly recommended. " The chlorine tooth wash," has 
been a fashionable remedy. We would advise those who are 
disposed to use tooth washes of any kind, to try their effect on 
the tooth of any animal, by immersing it in the fluid, for these 
washes are apt to contain acids, put into them for the purpose 
of " whitening the teeth. " A chlorine tooth wash might be 
made, that would be innoxious and useful : solutions of the 
chlorides of potash, soda, or lime, rendered pleasant by some 
of the aromatics, may be used with advantage. 



CLEANLINESS OF THE MOUTH. \ 

The East Indians, though looked upon by civilized nations 
as barbarians, are, nevertheless, worthy of imitation by them, 
in one particular at least, and this is the attention to cleanli- 
ness of the mouth. We have had frequent opportunities of 
conversing on this subject, with persons who have resided in 
India, and they agree in affirming, that the natives in 



162 Cleanliness of the Mouth. 

every part of the East Indies, pay great attention to their 
teeth. They are said to have better teeth than the inhabitants 
of any other part of the world, which we may fairly attribute 
to their habit of keeping the teeth and mouth free of foreign 
matter.* 

IMPORTANCE OF CLEANLINESS OF THE MOUTH. 

The importance of keeping the teeth perfectly free of foreign 
matter, has been illustrated in the consideration of " caries of 



* u The natives of India, says Dr. Lind, (who was in the service of 
the East India Company during twenty-five years, and travelled over 
every part of India,) rub their teeth with fibrous wood, draggon's blood, 
canes, and mallow roots, which cleans the interstices of the teeth." 

" The natives of Hindostan, the Bramins in particular, are extremely 
delicate in every point relating to the teeth; every morning when they 
rise, they rub them for upwards of an hour together with a twig of the 
raoemiferous fig-tree, at the same time addressing their prayers to the 
sun, and calling down the blessing of heaven on themselves and their 
families. As this practice is prescribed in the most ancient books of law 
and divinity, we may imagine it coeval with the date of their religion 
and government. It exhibits a curious proof of the regard which this pol- 
ished and scientific people had for the purity and beauty of the mouth, 
when so simple a practice is inculcated as a law, and rendered indis- 
pensible as a religious duty. 5 ' — Murphy, page 151. 

The natives throughout India, use a tooth powder, which they call 
mungun, prepared from the betel or areca nut ; its constant use gives to 
the teeth a reddish cast, which they consider as an acquisition to the 
beauty of them. 

" We respire, about twenty thousand times in twenty-four hours, 
and yet ; for months and years, this vast quantity of air is rendered poison- 
ous by one or more diseased teeth. How little does it avail an indi- 
vidual, if by every possible means the purity of the air is preserved ; if 
no impurities are suffered to remain in the streets ; if his tenements are 
kept clean, his apartments ventilated ; if he makes distant journeys at a 
great expense of time and money, for the benefit of pure air, and at the 
same time, carry the cloaca of filth in his own mouth 1 If the state of 
the breath, caused by bad teeth, so affects the olfactory nerves of a per- 
son near an individual having bad teeth, what must be its effect upon 
the delicate and sensible tissues of the lungs of the person himself? 
Nature has formed the lungs. most delicate and sensible, and susceptible 
to the slightest injurious imoressions: — She has also finely temper- 
ed the atmosphere for its safe and healthy reception in these delicate 
organs; but an accident, or a disease, may render it impure, unfit for 
respiration, and cause it, instead of harmonizing with the lungs in the 
most perfect manner, to exercise a baneful influence, armed with pesti- 
lence, and scattering the seeds of disease over the lungs, thus pouring 
the streams of deadly poison through every vein of the system."— Fitch 
on Hie Teeth, pages 300, 301. 



Cleanliness of the Mouth. 163 

the teeth, ** scurvy in the gums," and " tartar of the teeth," 
to which the reader is referred. 

When we consider that foreign matter is, directly, the 
grand cause of external caries, scurvy in the gums, and of an 
offensive breath ; and indirectly the cause of some serious 
local disease of the mouth and jaws, of derangement of the 
general system, and of much pain and suffering, it seems sur- 
prising that any person can be so unmindful of his interest 
and welfare, as to neglect to keep his mouth clean ; besides, 
one would suppose, that the luxury of a clean and wholesome 
mouth, Would be a sufficient inducement for procuring it, and 
amply repay the little time it costs. Notwithstanding, there 
are thousands who wholly neglect the teeth. Indeed, there 
are few comparatively, who keep their teeth perfectly free 
from foreign matter: though they may use tooth brushes, tooth 
powders, &c. yet they do not procure proper ones, or use them 
properly. We shall now use our best endeavors to point out 
the means, by which every person who has a healthy mouth, 
may keep his teeth perfectly clean. 

OF THE MEANS TO BE USED IN ORDER TO KEEP THE 
MOUTH CLEAN. 

The means to be used for the above purpose are tooth 
brushes, tooth picks, tooth powders, and on some occasions 
astringent and detergent washes. 

TOOTH BRUSHES. 

Tooth brushes of various kinds and shapes have been con- 
trived and are kept in the shops. There is much diversity of 
opinion among dentists as well as others, as to the kinds 
of tooth brushes best adapted for the purpose of keeping 
the teeth clean; some' recommending either hard or soft 
brushes, and others a medium. In this dilemma, it is difficult 
to give directions that shall prove satisfactory to all. People 
must (for they will) be governed in a great measure by their 



164 Cleanliness of the Teeth. 

own fancy ; still, we shall offer our candid opinions on this 
subject. And first, we do not approve of the use of a hard 
brush for these reasons. In brushing the teeth, a hard brush 
slips oyer them without entering their interstices, for its stiff- 
ness prevents this : hence those parts of the teeth most essen- 
tial to be kept clean, because they are the most liable to decay 
there, from the action of foreign matter, are not brushed at all. 
A hard brush is apt to tear and fret the gums, and has a ten- 
dency to occasion a recession or absorption of them from about 
the necks of the teeth, so that they appear somewhat longer 
than natural : we have often seen this effect produced by the 
constant use of a hard brush. On the contrary, we do not 
think that a very soft brush can be used with the greatest 
advantage. 

In the choice of tooth brushes, we generally recommend 
our patients, (or furnish them with such,) to get brushes of a 
middling* size, the bristles being well arranged, straight, and 
of considerable firmness, though not stiff, or too unyielding. 
These brushes we recommend to be rubbed with water on a 
sand brick, till the bristles are soft enough to enter the in- 
terstices of the teeth, and not chafe or fret the gums when the 
brush is freely used ; and these to be kept moist, or in a tum- 
bler of water, for use, as occasion may require. Any brush 
should be kept moist or it becomes stiff. Such a brush as the 
above, we always use in preference to any others which we 
have used experimentally. We depend more upon our tooth 
powder than our brushes, in keeping our teeth clean. We 
conceive that tooth brushes are generally thrown away, when 
they are worn enough to render them most useful. 

MANNER OF USING THE BRUSH, 

No definite directions can or need be given for this purpose 
The person who accustoms himself to the use of a tooth brush, 
always contrives to use it to suit himself. The brush should 
be carried longitudinally backwards and forwards across the 
teeth ; also moved freely up and down, that the bristles may 



Cleanliness of the Ttetk. 165 

snter and clean the interstices of them. Here again is the 
advantage of using such a brush as we recommend ; for a 
hard brush cannot be thus used with advantage. The teeth 
should never be brushed furiously so as to fret the gums, but 
deliberately. The advantage of carrying the brush up and 
down is very great, and is absolutely necessary in order to 
keep the teeth clean. In cleaning the interstices of the teeth, 
a hint may be taken from the habits of the natives of India : 
they rub the teeth up and down with the bruised ends of soft 
wood, canes, rattan, &c. with the mungun or betel nut tooth 
powder. 

Many persons do not brush the back teeth at all, and never 
the inside of them ; but merely brush the front teeth external- 
ly. Most persons do not brush the back teeth sufficiently. 
The brush should be so managed, that it shall clean every 
part of the teeth, between them, and on the inner side, as well 
as the outside of them; and with a little care this object can 
easily be effected. The front teeth of the lower jaw especial- 
ly, should be freely brushed on their inner side, for these teeth 
are more frequently encrusted with tartar than any others in 
the mouth, on account of their proximity to the sublingual 
d ucts, and from the circumstance of being more seldom brushed 
than the other teeth. These teeth are seldom lostby decay, but 
thousands of them are daily dropping out perfectly sound, 
encrusted with tartar, which has produced disease in the 
gums and sockets, their ruin being wholly the effect of neg- 
lect; for these teeth would never be lost after this manner, if 
they were kept free of tartar. 

Brushes of a peculiar shape are. kept at the shops for the 
purpose of brushing the incisores of the lower jaw, on the 
inner side. They may be used, but we think a common 
brush of considerable stiffness to be preferable, and is to be 
used by drawing it frequently out of the mouth, over these 
teeth, so as to enter between them. A napkin or handker- 
chief on the finger, may also be used with ad vantage. } 

From what has been said in previous chapters, it is evident 



166 Cleanliness of the Teeth, 

that cleanliness of the teeth is of great importance in the pre- 
servation of them. Few persons will be able to keep their 
teeth so free of foreign matter as could be desired, by means 
of the simple brush and water, though there is a very great 
difference in this respect, the tartar accumulating much more 
rapidly about the teeth of some individuals than others. It is 
generally necessary to have recourse to some kind of tooth 
powder in civilized life in order to effect this object. 

There is a great variety of opinions among people, as to 
the advantage of tooth powders: some use them once in two 
or three days, or a week : they are apprehensive that they 
may wear away the enamel so as to expose the teeth to decay. 
If it be necessary to use a tooth powder at all, it should be 
used every morning, at the time of rising, for these reasons. 
The tartar is constantly being deposited about the teeth from 
the saliva. If a person will observe his teeth in the morning, 
when he rises, he will perceive them to be coated with a yel- 
lowish slimy substance, which is the tartar that has been deposit- 
ed upon the teeth during sleep. When tartar is first secreted it 
is quite soft and can easily be removed with a tooth brush, but 
if it be neglected, it soon becomes concrete and hard, and can- 
not be removed without the aid of instruments: hence it 
should be daily removed. As a general rule, people do not 
use the tooth brush and powders, so freely as would be for their 
advantage. The prevalent opinion that the enamel may be 
easily worn off — that there is danger of doing this, by the daily 
use of a tooth powder, is founded in error — is a misconception. 
The enamel is a very hard and dense substance, so much so, 
that sparks may be elicited from it with a bit of steel. Be- 
sides, if the teeth be not kept free of foreign matter, how can 
the enamel be worn away? We never yet saw a set of teeth, 
worn out or injured by the daily use of a proper tooth powder; 
nor have we been able by inquiry, to find the person who has 
seen this much feared result. We do not wish, by any means, 
to inculcate such a principle as this, that there is no danger 
to be apprehended of wearing off the enamel, by the use of 



Clranliness of the Teeth* 167 

improper dentifrices ; or even that this substance cannot be 
worn off the teeth by the injudicious use of good tooth pow- 
ders; but we do contend, that there is no danger to be appre- 
hended from the daily use of suitable tooth powder, so as to 
keep the teeth perfectly clean and free of foreign matter, and 
of their natural polish. We have been in the habit^of using 
a tooth powder daily, as regular as the rising sun, for a great 
number of years, yet, we cannot perceive that our teeth are 
thereby worn away in the least. 

A great deal of mischief will be prevented by this procedure, 
for one grand secret in the preservation of the teeth consists in 
keeping them perfectly clean and highly polished. Teeth, 
having their natural polish, are easily kept clean, for foreign 
matter does not readily adhere to a polished surface, which is 
not the case with a rough one. Few persons, very few indeed, 
keep their teeth perfectly free of tartar ! The enamel is destroy- 
ed ten times more rapidly by the chemical action of foreign 
matter, than it can be by the use of any rational tooth powder. 

Finally, in the use of tooth brushes and dentifrices, we 
would recommend strict adherence to the following maxim. 

Keep the teeth perfectly free of all foreign matter and preserve 
their natural polish. If this object can be effected by the daily 
use of a brush and cold ivater, (which is seldom the case,) they 
are all that are required or proper ; but if not, a proper tooth 
powder should be used daily in addition, just freely enough to 
accomplish this purpose. 

< It is an excellent plan to brush the *teeth in the evening be- 
fore retiring, to remove any particles of food that may adhere 
to them. This habit renders the mouth delightfully sweet, 
and is very grateful to those accustomed to it, and thus amply 
repays them for their trouble, and must prove of advantage 
in the preservation of the teeth. 

In brushing the teeth, water should be used of that tempra^ 
ture, most agreeable, and not cold enough to produce painful 
sensations in them. 



108 Tooth, Foivtkrs. 



TOOTH PICKS. 



Tooth picks, though so trifling, we conceive to be dental im- 
plements of great utility : they should be in the pocket of 
every gentleman and used after every meal, to remove the 
particles of food lodged between the teeth, in order to prevent 
its decomposition and consequent effects. If tooth picks are 
of so much service to gentleman, why may not their use prove 
of advantage to ladies also ? We would strongly recommend 
them to give it a place in their boudoir. 

Tooth picks are made of gold, silver, steel, ivory, tortoise 
shell, and of goose quils. The best dentists of the age do not 
approve of the use of metalic tooth picks, thinking them to be 
injurious, or not so useful as other kinds, those made of tor- 
toise shell answer a better purpose ; but one made of a com- 
mon goose quill is to be prefered to all others : it becomes quite 
soft and yielding in the mouth and may be used with impunity. 



TOOTH POWDERS. 

la no part of the dental profession has more whim, fancy, 
ignorance and empiricism prevailed, than in the inventions of 
tooth powders : some have exerted their wits to find out a 
dentifrice that should in itself prove a penacea for the teeth ; 
others for lucre's sake, to compound one that should please 
the people by making the teeth beautifully white. 

From the earliest era of medical science, in all countries, a 
great variety of recipes for tooth powders have been handed 
down to us, some the most singular and absurd in their com- 
position. One would suppose, in looking at the formulas for 
dentifrices given by the ancients, that they vied with each 
other in the greatest number of articles, some of them the 



Tooth Powders. 169 

most absurd and ridiculous, and too indelicate to be repeated, 
Even some of the materials used in modern times are equally 
absurd ; such as calcined bones, egg shells, crab's claws and 
eyes, fishbones, mother of pearl, to which may be added soot, 
scotch snuff, ashes of the cigar or of tobacco, &c. in common 
use : these however possess the virtue of being harmless, 

A great deal of mystery has ever hung over the composi- 
tion of tooth powders : it is essential to the sale pf them, as it 
gives full scope for puffing qfFtheir virtues and imposing on the, 
credulous man ; for deprive any remedial agent of the charm 
of mysterious composition, and he will not look at it. 

In composing tooth powders, we should refer to the object 
of them, which is to keep the teeth free of foreign matter, and 
sometimes, to possess an astringent property. To effect this 
object, all acid substances are highly improper; therefore, we 
are to choose mechanical agents : it matters not much* as to 
utility, what kind of mechanical subtances we employ, pro^ 
yided they bd properly prepared, and innoxious, but we shoulc| 
prefer those most pleasant.* 



f lt All the argillaceous earths form good tooth powders when mixed 
with some aromatic."— Dr. Hooper, 

" A tooth powder is rarely of little use except as a mechanical aid 
to the brush. The aromatics which enter into these compositions are oi ? 
no use to the teeth, though they may certainly be more or less useful to 
the gums ; myrrh, bark, and other drugs can neither whiten the teeth 
nor preserve them. Bearing in mind, that the use of a tooth powder is to 
assist the action of the brush, those substances should be chosen which 
can be finely levigated, and which have no tendency to wear away the 
enamel. The testaceous powders, therefore, in combination with some 
alkaline should be preferred. The best tooth powders in my opinion are 
composed of such ingredients as the following, 

Take of Prepared chalk, - - - - 3 drachma 

" ? c ' Castile soap, - - - - - 1 " 

" Orris root,'- ----- 2 " 

" Carbonate of sodaj - - - 1 Jf 

!? I have generally found that after the teeth have been perfectly clean- 
ed with instruments, they are kept free from tartar,' by brushing them 
once or twice a day wi'.h this powder. ' J — Snell, page 199. 

" In those constitutions in which there is a peculiar tendency to the 
formation of tartar, it will be necessary to have recourse to the daily use 
of some simple tooth powder, such as prepared chalk, or any other sub- 
'* S ' 



170 Tooth Powders. 

The very best tooth powders may be prepared from some of 
the following substances, and can be obtained in any quanti- 
ty of the druggist. 

Substances that act mechanically. — Prepared chalk, pumice 
stone very finely pulverized, Armenian bole, and charcoal. 

Astringent substances. — Peruvian bark, orris root, gall-nuts, 
and myrrh. 

Aromatic substances, — Cinnamon, cloves, and the essential 
oils. 

Chemical substances. — Carbonate of soda, and soaps. 

Many others might be added to the above, but they are 
enough and are to be preferred. 

In compounding a tooth powder, the base or mechanical 
agents are first to be chosen, and then the other substances 
are to be added according to the purpose for which they are 
intended. Tooth powders possessing different mechanical and 
medicinal properties are required for different individuals. 
We will give a few formula as examples : the following is 



stance equally soft and simple. If the gums are spongy and lax, 
powdered myrrh or bark, maybe added with advantage." — Thomas 
Bell, 'page 200. 

" The best method to effect this, (to keep teeth clean,) is with a brush 
and water ; should this prove insufficient, powders composed of Arme- 
nian bole, prepared chalk, peruvian bark, or charcoal, maybe used with 
great advantage. The interstices of the teeth may be cleaned by pas- 
sing between them a thread of waxed silk, thereby to dislodge whatever 
may have collected on their sides." — Parmh/s Notes to firowrts Den- 
tolopia, page 174. 

" Qualities of Tooth Powders.-r-Soot acts by mechanical friction, 
but not superior to any bitter powder, as bark, &c. — chareoal acts me- 
chanically byfits friction : burned bread the same. Gun powder produces 
no effect but through the charcoal and nitrue it contains. Alum is a 
most mischievous application to the teeth, being the produce of oil of 
vitriol and clay. It is a very strong styptic ; but on coming in contact 
with the teeth, it i3 immediately decomposed, the acid uniting with the 
teeth. Salt, perfectly innocent, although not serviceable. Nitre, er 
ealt-petre, a valuable application to inflamed gums, removing the rough 
viscid slime, which, in some, collects over the teeth and mouth ; it is a 
useful gargle and does not act on the teeth. Cream of tartar, improper ; 
acts on the enamel. Mixtures of soot, salt, soap, &c. &c. remarkable 
onty for their nauseous qualities."— J. Fuller^ page 65. 



Tooth Powders. 171 

an excellent one for common use. 

Take of Pumice stone, - - - - 1 part 

44 Prepared chalk, - - - 4 " 

44 Orris root, - - - - - l£ " 

44 Carbonate of soda, - - 1 4A 

44 Cinnamon, - - ■*■ - £ 44 

The ingredients should be finely pulverized. The pumice 
stone and chalk act mechanically; the orris root is a mild and 
delightful astriagent ; the carbonate of soda acts on the same 
principle as soap, and the cinnamon makes it more pleasant. 
Any of the essential oils may be used for the last purpose as 
in the following fomula. 

Take of Pumice stone, - - - - 2 ozs. 
44 Prepared chalk, - - - 8 44 

14 Orris root, 3 44 

44 Carbonate of soda, - - 2 44 
44 Oil of Cinnamon from 20 to 40 drops, mora 
or less according to fancy. The oil of cloves, anise, roses, 
bergamotte, thyme, rosemary, lavender, lemon, &c. &c. may 
be substituted, or used in combination. Myrrh, camphor, 
myrtle, amber, musk, &c. may also be added. By the com- 
bination of these materials, tooth powders may be composed 
possessing " all the delightful fragrance of Oriental perfume." 
Any person may use tooth powders composed as above with 
impunity. 

When there is a great constitutional disposition to the for- 
mation of tartar, a tooth powder possessing greater mechanical 
action must be used in order to keep the teeth free of that 
substance, as in the following fomula. 

Take of Pumice stone, - - - - 1 part 

44 Armenian bole, - - - 1 44 

44 Prepared chalk, - - - 2 4 > 

44 Orris root, ----- $ « 



172 Tooth Powders. 

14 Carbonate of soda, - - 1 ** 
'* Cinnamon, ----- $ " 

Tooth powders may be colored with a little crocus, rexl- 
earth, Armenian bole, draggon's blood, carmine, redlake, &c. : 
crocus gives to a tooth powder, a pretty color. 

Astringent tooth powders. — These powders may be com- 
posed by adding gall-nuts, oak bark, or peruvian bark to one 
of the fomula just given, or thus : 

Take of Pumice stone, - - - - 1 part 
" Prepared chalk, - - - 2 " 

" Orris root, 1 " 

Gall-nut, i " 

" Carbonate of soda, - - 1 " 
44 Cinnamon, ----- h " 
Or, take of Prepared chalk, - - - 4 ozs. 
44 Peruvian bark, - - - 1 " 

44 Orris root, 1 " 

44 Myrrh and camphor, of each 1 drachm. 

44 Nitre, 1 44 

44 Cinnamon, 4 44 v 

Either of the above forms may be used with advantage, 
when the gums are diseased : directions for the use of astring- 
ents have been given under the subject of scurvy in the gums. 
(See page 143.) Tooth powders or washes cannot be of much 
service in the cure of diseased gums, unless the causes of the 
disease be previously removed. 

In conclusion of this subject, we make the following extract 
from Mr. Snell's work on the teeth, page 199. 

44 Almost all the tooth powders prepared for the shops are 
injurious, and deserve public censure in a similar manner to 
what took place in Paris, in 1793. A tooth powder to be 
popular, must make the teeth white : this is usually accom- 
plished by the use of acids. Many dentists make a great 
secret of their compositions. No man of science can be de- 
ceived by such charlatanism. 



Tooth Ache. 173 

» 

" Charcoal is highly spoken of. There are however, two 
strong objections to it : first, it cuts through hard substances 
rapidly, and its improper use may destroy the enamel ; and 
secondly, it is a very dirty application to the mouth. When 
it is used, that which is made from the areca nut, or from 
the vine shrub is to be preferred." 

Charcoal, when used as a tooth powder should be very 
finely pulverized, and made from soft, ratHer than hard wood i 
we think that there are many other substances to be preferred. 
Charcoal has been strongly recommended as a dentifrice, for 
its antiseptic property : as applied to the teeth, this does not 
amount to much. Dr. Torey recommends animal charcoal* 
or ivory black, for a tooth powder. 



TOOTH ACHE. 

Tooth ache is caused by two diseases, which *re denomi- 
nated odontitis and periostitis. The former is an inflamma- 
tion of the internal membrane or nerve of the teeth, and the 
latter is an inflammation of the periosteum or membrane which 
lines the sockets of the teeth and holds them in the jaws. 

Perhaps there is no pain more acute than that sometimes 
experienced from tooth ache*, and therefore none more to be 
dreaded, as most or many persons can bear witness. The 
throbbing acuteness of the pain of odontitis, arises from the 
confined situation of the internal membrane; the cavity of 
the teeth not permitting that distention or swelling which ac- 
companies inflammation ; hence, the pressure upon the nerve 
causes the most acute pain.* 



* The following characteristic lines are from the f Address to the 
Tooth ache/ by Robert Burns : — 

n My curse upon your venomed stang, 
That shoots my tortured gums alang, 



174 Tooth Ache. # 

There are a thousand remedies for the tooth ache; the 
shops are full of nostrums : tincture of opium, ether, cam- 
phorated spirits, the essential oils, as oil of cloves, are as good 
as any of them. Caustics have been much used, (and these form 
the base of all quack remedies,) for the purpose of destroying 
the nerve, as the nitric, muriatic or sulphuric acids ; of these, 
the nitric is the best, as it has a powerful affinity for animal 
matter, and destroys it without much pain. The nitrate of 
silver, (lunar caustic) was a favorite tooth ache remedy with 
the great surgeons Hunter and Abernethy, a bit being intro- 
duced into the painful tooth. Other caustics have been used. 
One great objection to these substances is, that they destroy 
or injure the teeth. The most effectual and least painful means 
of destroying the nerves of the teeth is arsenic, and we most 
strenuously recommend its use for this purpose. Thousands 
of teeth are daily being extracted that may easily be preserv- 
ed, often for a great number of years, by the application of 
this remedy and plugging the teeth afterwards. (See method 
of using the arsenic, page 115.) 

Kreosote has lately been used as a powerful remedy for the 
tooth ache : it frequently acts like a charm* But the most 
powerful of all temporary remedies, that we have ever used, 



And through my lugs gi'es mony a twang, 
Wi' gnawing vengeance ! 

Tearing my nerves wi' bitter pang, 

Like racking engines! 

c< When fevers burn, or ague freezes, 
Rheumatics gnaw, or cholic squeezes, 
Our neighbor's sympathy may ease us 

Wi' pitying moan ! 
But thou — the hell o' a' diseases, 

Ay mocks our groan! 

l( Where'er the place be priests ca' hell, 
Whence a' the tones o' misery yell, 
And ranked plagues their numbers tell, 

In dreadfu' raw ; 
Thou— tooth ache, surely bear'st the hell, 

Amangst them a.' il 



Tooth Ache. 175 

is either the acetate or sulphate of morphia, (morphine :) the 
powder is introduced into the painful tooth on a little cotton 
twirled round the end of a probe. The acetate of morphine 
is said to be the active agent in Clark's celebrated Anodyne 
Tooth Cement, for curing aching teeth ; by which the inventor 
is said to have made a fortune. Morphine is a most powerful 
medicine, and therefore should be used with great caution. 

As it is evident that all temporary means for relieving tooth 
ache are of no permanent advantage, and that, the pain will 
in all probability continue until the nerve has perished, it is 
best to take measures at once, to effect a permanent cure ; 
therefore a dentist should be consulted, who will either reduce 
the inflammation of the nerve and plug the tooth, or, if this 
cannot be done on account of the nerve being too much ex^ 
posed, he will destroy it, or advise extraction. If the tooth be 
too much decayed to admit of preservation, it should be ex- 
tracted at once, as this must be the ultimatum. 

By this means, a great deal of sufTering will be prevented, 
and the patient rid of a troublesome, offensive and injurious 
body. A tooth that is not of service, should never be permit- 
ted to remain in the mouth, on account of the pain and irrita- 
tion which it occasions, and the injurious effect it has, in 
inducing decay in the other teeth. 

It is astonishing how r much pain many persons, of a timid 
disposition, will suffer before they can be prevailed upon, un- 
der any circumstances, to consult a dentist. 

The truth is, that the pain of all dental operations is terri- 
bly exaggerated. Most persons who have not had experience, 
dread any operation on the teeth, as though it were an opera- 
tion of the first magnitude, that is, an operation in which life 
or death will be the result. Dental operations as a general 
rule, if early performed, are not very painful. Every person 
can bear them, and laugh while they are being performed. 
The extraction of the teeth is painful, but not so much so as 
is generally imagined. 

When the pain arises from inflammation in the socket, the 



176 Tooth Ache. 

t%th H as become a foreign and extraneous body, its nerve 
having perished ; therefore, it is best to remove such teeth as 
a general rule, for though the inflammation will subside, and 
resolution take place, yet they will be subject to like attacks,' 
every time the patient takes the least cold, till they are re- 
moved* The periosteum has become disorganized, and all 
vascular and vital connexion existing between it and the fangs 
destroyed; 

Periostitis frequently terminates in gum-biles, w r hich arc! 
very troublesome and painful* Sometimes the inflammation 
Spreads to the contiguous parts, and a swelled face is the con- 
sequence* In such eases it is advisable to foment* the face* 
and open the abscess as soon as it comes to a head, and when 
the swelling has subsided, to extract the cause of the mischief. 

Whenever a tooth becomes dead, nature, ever watchful of 
her charge, endeavor to remove it, and she effects this process; 
by causing an absorption of the periosteum and sockets, and a 
deposition of ossific matter at the bottom of the sockets, which 
gradually protrudes the teethi 

The fangs of teeth, the cfowns of which have decayed awayv 
are always removed by this process, if left to nature ; verjr 
often the dead fangs are completely thrown out of their sock- 
ets, and lie flat on the gums to which they adhere. 

When there are many carious and painful teeth and stumps* 
in the mouth, the health is often injured, from the constant 
and continued pain and irritation, which perfectly unfits the 
patient for exercise, of either body or mind, and frequently he 
Is driven almost " mad with the tooth ache," and sleepiest 



, * The belt fomentation for a swelled face, in our opinion, is the fol~ 

lowing: • . 

Ta-'.e a handful of camomile flowers and one large popy head, 
and pour on them, a quart of boiling Water i flannels folded several 
times, are to be wrung our of the infusion and constantly applied to th6 
(V.e till the pain abates. The infusion may also be held in the mouth. 

An infusion of tho hop, also makes an excellent fomentation for the 
above purpose. A popy head or a few drops of laudanum may be added 
-Vith advantage; 



Tooth Ache. 177 

iiights are far from mitigating that febrile state of the system, 
always the concomitant of irritation. 

Frequently, sympathetic pain is felt in the face, temples, 
eyes, and in the ears; a reference to the nerves of the face 
will explain the cause. (See page 171.) 

When the wisdom tooth is affected, ear ache is a common 
consequence, and the reflected branch, called the chorda 
tympani, which joins the seventh pair or auditory nerve 
explains this fact. 

Sympathetic head ache is also an occasional consequence 
of bad teeth. All these facts are explained by the intimate con- 
nexion, that subsists between the nerves distributed to these 
parts. 

It often happens that a patient cannot tell which tooth is 
painful, and points out a tooth in the upper jaw as the one he 
ihinks diseased, while the real cause of the pain is situated in 
the lower jaw, and vice versa. The removal of the affected 
tooth gives relief. Not unfrequently, a patient will point out 
a sound tooth as the one painful, and it may be hard to con- 
vince him of his error. We have known sound teeth to be 
extracted to gratify the whims of patients, or for the benefit of 
the operator's pur.se. A person who has the hardihood to ex- 
tract a sound tooth under such circumstances, ought to be 
hanged* 

It is very extraordinary that the pain of tooth ache should 
he so much under the influence of the passions of hope and 
fear : an individual about to have a tooth extracted very often 
declares that the pain has left him, though it was before jump- 
ing. Empirics have taken advantage of this circumstance, 
and pretended to cure tooth ache with charms and various nos- 
trums, and succeed at the time, but the patient is no sooner 
out of the influence of the secret agent, imagination, than he 
suffers penance for his credulity. The burning of the antihe- 
lex of the ear, for the cure of tooth ache owed its popularity to 
the effect of the passions. 



1?8 Importance of the Teeth 

This notion were not worthy of notice, but for amusement, 
as any one will perceive that a division of any part of the ear 
cannot effect the nerves of the teeth, as they are derived from 
a different source* 



Importance of the teeth to the 
animal economy. 

The human system may be compared to a very complicated 
but perfect machine, all of whose parts are essential to its 
perfect operation. 

When the physiologist first contemplates the structure of 
the human body, he is struck with its apparently Complicated 
nature ; but as he examins it, he perceives the beautiful sim- 
plicity by which the different organs and parts constituting a 
perfect whole, all o( which are essential to its perfection. To 
each organ is assigned a particular and important function, 
and in health, all the organs act in unison and thus promote 
each others action; but when one organ becomes disordered, 
it is a law of nature that the whole must surfer more or less 
in proportion to the injury: hence, there is no part of the 
animal system but that is essential to its welfare* The im- 
portance of the teeth may be illustrated on this principle. The 
performance of the functions of the teeth is essential to the 
welfare of the animal economy ; and hence most animals are 
furnished with a masticatory apparatus, and the loss or destruc- 
tion of this apparatus is attended with serious consequences, 
as is seen with some domestic animals, which, under such 
circumstances, dwindle away and die. The loss of the teeth 
does not prove so serious to man, as he can contrive means 
for preparing his food for digestion ; yet even to him, the mas- 
tication of the food, and its commixture with the saliva is 
essential to digestion, By making the stomach perform the 



To the Animal Economy. 179 

functions of the teeth, it becomes deranged and a trian of evil 
consequences follow. 

44 The importance of the teeth is such, that they deserve 
our utmost attention, as well with respect, to the preservation 
of them when in their healthy state, as to the methods of 
curing them when diseased* They require this attention, not 
only for the preservation of them, as organs useful to the body, 
but also on account of the other parts with which they are 
connected ; for diseases of the teeth are apt to produce 
diseases in the neighboring parts, frequently of very serious 
consequences." — Hunter, page 131. 

The teeth are essential to articulation. 

44 If the great distinctive attribute of man be the faculty of 
speech, that speech can never be complete or perfect, without 
two arches of teeth to modulate the sound and give proper 
utterance to the words. Indeed, it is obvious to every one, 
that when the teeth are lost, the speech becomes imperfect, 
and often scarcely intelligible. 

44 This circumstance makes them valuable beyond measure 
to a public speaker, and their preservation ought to meet due 
attention from those who wish to shine, either in the senate, 
at the bar, or in the pulpit. 

44 Without these instruments of utterance, the graces of 
eloquence are lost, and the power of impressing the mind or 
convincing the understanding, if not destroyed, is considera- 
bly diminished." — L. S. Parmly's Lectures, page 42. 

A loss of the teeth is not only injurious to the general sys- 
tem, but it produces sad deformity. 

44 In consequence of the complete, or even partial ruin of the 
teeth, the face shrinks, the voice looses its harmony, and the 
pronunciation is very imperfect. The countenance assumes 
a different expression, is hard or morose ; the flesh of the 
cheeks flag and hang down, and wrinkles prematurely fur- 
row the face. The mouth and nose also change ; the chin 
seems to be longer and approaches much nearer the latter 



180 Importance of the Teeth 

organ, ( 4 a pair of patent nut crackers :') in short, every part 
of the face is deformed, and presents the anticipated sight of 
painful destruction."— Gerbeaux, 'page 31. 

The teeth are essential to personal appearance or beauty.* 

" Without its aid how hard were woman's lot, 
To die neglected, and to sigh forgot." 



* " The teeth are the greatest ornament of the human countenance ; 
their regularity, their whiteness constitute their beauty t these qualities 
please the sight, and add new attractions to the face. Should the mouth 
exceed in magnitude its common size, a fine set of teeth will disguise 
the defective conformation, and frequently such is the prepossession 
which results from a fine set of teeth, that the same mouth would appear 
defective if it were smaller. Were you to see a woman laugh, whose 
wide mouth discovers thirty -two dazzling pearls, you would feel no 
temptation to scrutinize the extent of the diameter of her mouth ; your 
whole attention will be directed towards the beauty of her teeth, and the 
graceful smile that exhibits them. This ornament is equally becoming 
tb both sexes *, it attracts attention when found in man, and spieads a 
kind of amiableness over his countenance, by softening his features : 
those of the black African cease to frighten the timid beauty when he 
displays his dazzling white teeth. But it is chiefly to women that fine 
teeth are necessary, since they are intended to please our eyes, prior to 
captivating our hearts. What justifies the pre-eminence I give to the 
teeth over the charms of the face, is the influence which they exercise 
over beauty : let a female be possessed of fine eyes, a pretty mouth, a 
pretty nose, a fine forehead, beautiful hair, and a charming complexion; 
if she has ugly teeth, vitiated, broken, covered over with thick fur, or 
with a slimy covering, if, in short, they sen'd forth a corrupt smellj 
(which her neighbors find out before she does herself,) she cannot be 
thought handsome from the moment she opens her mouth ; she herself, 
conscious of the sad effect of her smiles, acts with constraint, and has 
recourse to grimace, with a view of concealing the injury which her 
teeth have endured. If, on the contrary, she should have a large nose, 
small eyes, if even she were ugly, provided her teeth be regularly plac- 
ed, that they be white, and especially that she retains her full number, 
or at least all that can be seen ; unless, indeed, that woman was a true 
fright her face will appear agreeable as soon as a smile comes to her 
assistance ; and you will hear the observations so consoling to her vani- 
ty : "she has fine teeth," "beautiful teeth, " "splendid teeth." — Ger- 
beaux. Dlctionnaire des sciences Medicales par M. Fournier. 

There are d ifferent opinions amon? nations as to what constitutes beau- 
tiful teeth. Civilized nations consider sound, well formed, regular and 
whi'e teeth, the most beautiful. There are ravage or barbarous nations 
who entertain a different opinion, and have various fancies about their 
teeth ; some think they cannot be too black to be beautiful. The married 
women of Java dye their teeth black, which is supposed to be a mark 
ef distinction. The women of the Marian Islands also blacken their 
teeth. The inhabitants of Sumatra and Malacca have the same custom ; 



2h the Animal Economy, 131 

EFFECTS OF DISEASED TEETH GUMS AND SOCKETS 
UPON THE CONSTITUTION. 

It is a law of the animal economy, that when any part of 
the system is diseased, the whole system becomes sympatheti- 
cally affected, and suffers in proportion to the extent of the 
local malady, modified by its seat, the constitution and the 
state of the general system. Hence, the disease of the teeth 
and their appendages must affect the constitution, and from 
their situation and the intimate connexion existing between 
the nerves of the teeth and of the general system, by means of 
the fifth pair and great sympathetic nerve, the constitution 
must sometimes suffer severely, as a thousand facts constantly 
occurring amply prove. 

The local affections caused by diseased teeth, gum and 
sockets, are sympathetic pains in those parts most intimately 
connected with them, as pains in the face, inflamed eyes, ear 
ache, nervous head ache, tic-doloureux, defective smell and 
taste, and diseases of the jaw bones : most of these are at 
once explained by referring to the fifth pair of nerves, which 
is the grand medium of sensation to the face and head. 
(See page 170 

There can also be no doubt but that diseases in the 



these people are said to blacken the teeth from an idea they entertain, 
that men ought not to have white teeth like brutes. The Toquinese 
and Siamese also employ every art for this purpose. 

In some of the East India Islands, the people gild the two front in- 
cisores of the upper jaw, and blacken the adjoining teeth. In New Zee- 
land and some other Islands m the Pacific, a golden tooth is an ensign 
of royalty. 

Some savage tribes have fanciful notions as to the shape of the teeth. 
The Abyssinian negroes file off the corners, so as to make them spear 
pointed. The Mallay Indians cut groves across the incisor cs of the 
upper jaw. 

The savages on the northwest coast of America, have a whimsical 
custom with respect to the mouth. These people appear at first sight 
to have two mouths, which effect is produced in this manner. They 
make an incision through the upper lip, parrallel with the mouth, and 
when the wound has healed, they adjust a shell to the artificial mouth, 
which is cut to resemble a row of teeth. 



182 Importance of the Teeth 

mouth often severely affect the constitution, and are con- 
ducive to several diseases of the general system: this 
will not appear supposing, when we consider the intimate 
connexion existing between the teeth and their relative parts, 
and between these and the general system — the great irrita- 
tion that is frequently going on in the mouth, from extensive 
disease in the teeth, gums and sockets — the immense quantity 
of morbid matter discharged — the great pain often experi- 
enced — the imperfect manner in which the function of masti- 
cation is performed, and the importance of this function to 
digestion, and the peculiarity of constitution in different iridic 
viduals. That the local diseases of the mouth have consider- 
able effect upon the general system, is sanctioned by some of 
the best medical writers, and is amply proved by the many 
cases on record, and the many occuring every day to the ob- 
servation of the physician. Every one is aware of the violent 
constitutional derangement that so frequently occurs fiom 
tooth ache, swelled face, gum-biles, &c. 

The exciting causes of the malignant diseases of the jaw 
bones, of such frequent occurrence in this country, and always 
requiring a formidable operation, (no less than the partial or 
complete extirpation of the jaw affected,) to prevent a fatal 
termination, are undoubtedly local diseases of the teeth. 
There is always something constitutional that predisposes to 
malignant diseases, yet they generally remain dormant, unless 
some local injury bring them into action. So with the diseases 
of the jaws; they do not often make their appearance, unless 
there be local irritation from dead teeth and stumps, from dis 
eases of the gum and sockets, or injury done to the jaw by the 
operation of extracting the teeth. 

That distressing malady, tic-douloureux, or nerve ache of the 
face often, according to dental writers, and even some medical 
w r riters, (and they cite an abundance of cases to prove it,) are 
often produced by the diseases of the mouth. We have seen 
two well marked cases of this disease, and that it was 
caused by the diseased state of the teeth and gums, is provecj 



To the Animal Economy. 183 

by the fact, that a perfect cure was effected, by directing the 
treatment to the mouth. 

" The preservation of the teeth is of the utmost importance 
not only as organs useful to the body, but on account of other 
parts with which they are connected ; for diseases of the teeth 
are apt to produce diseases in the neighboring parts, frequently 
of very serious consequence, 

" One might at first imagine, that the diseases of the teeth 
are very simple, and like those which take place every where 
else in the bony parts of our body; but experience shows the 
contrary. The teeth being singular in their structure have 
diseases peculiar to themselves. These diseases considered 
abstractly, are indeed very simple; but by the relations which 
they bear to the body in general, and to the parts with which 
they are immediately connected, they become extremely com- 
plicated. The diseases which may arise in consequence of 
those of the teeth are various, such as abscesses, carious 
jaw bones, &c— Hunter, page 132. 

'* When we consider how often the teeth, when decayed, . 
are exposed to irritation from hot and cold drinks and aliments, 
from pressure by mortification, and from the cold air, and how 
intimate the connexion of the mouth is with the whole sys- 
tem, I am disposed to believe they are often unsuspected 
causes of general and particularly of nervous diseases. When 
we add to the list of those diseases, the morbid effects of the 
acrid and putrid matters which are sometimes discharged 
from carious teeth, or from ulcers in the gums created by 
them, also the influence which both have in preventing per- 
fect mastication, and the connexion of that animal function 
with good health, I cannot help thinking that our success in 
the treatment of all chronic diseases would be very much pro- 
moted by directing our enquiries into the state of the teeth in 
sick people, and by advising their extraction in every case in 
which they are decayed." — Dr. Rush's Medical Enquiries, 
Vol. I. page 201, 



184 Importance of the Teeth 

IMPORTANCE OF THE PRESERVATION OF THE BACK 
TEETH. 

Many persons do not appear to care much about the preser- 
vation of the back teeth, though they are very anxious to pre- 
serve the front ones for appearance's sake ; those teeth out of 
view being thought comparatively of little importance. The 
loss of the back teeth not only destroys the masticatory appa- 
ratus, and is thus conducive to derangement of the digestive or- 
gans, and the whole system, as well as being productive of the 
local diseases of the mouth and jaw bones, but their loss is very 
apt to occasion the premature decay of the front teeth ; for in 
this case, the whole force of mastication comes upon them, and 
this undue action, being constantly exerted, wastes their sub- 
stance, or occasions disease in their sockets, and at length they 
drop out perfectly sound. Hence the preservation of the mo- 
lar teeth is of more importance than of the incisores. Another 
circumstance, if the back teeth be preserved, so as to keep the 
jaws asunder, artificial teeth maybe substituted and used with 
great ease and comfort, in case of the loss of the front teeth ; 
but reverse the supposition, and artifical teeth cannot be em- 
ployed with any comfort, unless a whole set be substituted, for. 
obvious reasons. 

OPERATIONS ON THE TEETH OF PREGNANT WOMEN. 

" The prejudices existing against dental operations during 
the time of pregnancy, are founded on the mal-practices of 
daring men, or [of unskillful operators, and hence the preva- 
lent notion that it is better to suffer from a slight disease, than 
from a painful and hazardous dental treatment. 

" 1 have never been deterred from performing any opera- 
tion, the necessity for which was sufficiently indicated, by the 
circumstance of pregnancy, or of suckling, provided the indi- 
vidual was willing to submit to it; and particularly, if the 
object was to relieve the patient from immediate suffering. A 
judicious treatment of the teeth and gums, when circumstance! 



To ike Animal Economy. 185 

require such treatment, will not only benefit the health of the 
mother but of the child. 

" In the year 1819, in the presence of William P. Dewees, 
M. D. and Lecturer of Midwifery, &c. of Philadelphia, I ex- 
tracted fifteen decayed and dead teeth and roots in the space 
of twenty-five minutes, from the mouth of a lady who was, I 
believe, in the fifth month of her pregnancy, and the result 
was immediate relief and eventual benefit to the health of the 
mother, and impunity to the life and health of the child. 

41 This case and many others which occurred under the im- 
mediate observation of two of the most eminent accoucheurs 
of the United States, viz. Nath. Chapman, M. D. and Prof, 
of the Instit. and Prac. of Medicine in the University of 
Pennsylvania, and Dr. Dewees, whom I have already men- 
tioned, had in a great measure the effect of removing the pre- 
judice against dental operations during pregnancy from the 
minds of the liberal members of the Medical Faculty in Phi- 
ladelphia ; a prejudice too frequently entertained, not only by 
the public at large, but by physicians and surgeons ; and 
generally productive of much suffering to the mother, and no 
doubt of injury to her child yet unborn. 

* A The effect of such a treatment depends in a great measure 
on the judgment and skill of the dentist ; and in the absence 
of the required skill and judgment, the individual would ne- 
cessarily be exposed to the danger of the malpractices of Den- 
tal Surgery, and especially of the barbarous methods in which 
the various operations are so frequently performed. 

44 In the conduct of such operations, it would be the obvious 
duty of the dentist to watch carefully the immediate effects 
of such operations, both upon the mind and upon the body 
of his patients, and to judge how far their powers might be 
capable of supporting the unavoidable irritation and pain 
produced by them ; a duty, however, of which the perfor- 
mance could not be reasonably expected from a mechanical 
and ignorant operator. " — Koecker page 137. 

We think the above observations of Mr. Koecker very judi- 
8* 



186 Importance of the *Teeth to the Animal Economy* 

cious* That the teeth of women are more subject to decay* 
and decay faster during pregnancy than at other times; is a 
fact long noted in the records of medicine 5 and it is surpris- 
ing how much some women suffer from tooth ache; and its 
concomitants, during this state, rather than submit to any 
dental treatment. As a general rule, operations may be pet* 
formed on the teeth during the pregnant state, without incuring 
any risk : we have frequently seen this put to the test of experi- 
ence, and have often done it ourself 

No person, hewever, who understands himself, will be so 
rash as to perform these operations, under the above circum- 
stances, without consulting the condition of his patient, and 
the state of her nervous system. 



MANAGEMENT OF THE TEETH 



FROM 



INFANCY TO OLD AGE. 



la this chapter, which we devote to the management of the 
teeth, we shall attempt to give such general directions, in a 
summary manner, as we deem requisite for the care and 
proper management of them, in order to their preservation, 
from the time of their appearance to old age. And as no 
single individual can exercise the proper care for the same 
set, through this entire period, our observations or directions 
will be made for a guide to nurses, mothers, and to such as 
may attempt to manage the teeth during infancy and youth, 
as well as to the individual possessor of them, who, it is sup- 
posed, after a certaia age, will take that office upon himself. 
And, as we intend these directions for popular or general use, 
as a kind of chart or directory to all who may desire to be di- 
rected, our observations must necessarily be general and brief; 
and we shall study to have them couched in as plain and fa- 
miliar language, as possible, and not be so scrupilous about 



ioo Management of the Teeik 

method, accuracy of discriptive and professional diction, as if 
we were writing solely for professional readers. Yet, as it 
will be necessary to adopt some order, we shall take up ihU 
subject at early infancy, and follow it up progressively to old 
age, with as much precision as the nature of it, and our pro- 
posed manner of treating it, will admit. This order, thougti 
objectionable in some respects, is the most natural one that 
we can adopt; and though the appearances which we de- 
scribe may not be exhibited in every diseased mouth ; and if 
they be so, are not exhibited at the exact period which we 
assign to them, in our order of description, yet, in a majority 
of mouths, they will obtairL 

Another reasdh justifying us iri hot being methodical in out 
discriptidri bf diseases? is the circumstance, that they have 
been fully treated of in other parts of the work. 

Well then, to proceed to our subject, let us place before us 
an infant 4 or 5 months bid and examine its mouth attentively; 
we find its jaws regularly formed, their arches evenly turned, 
their opposite surfaces or edges smooth and uniform; the 
arch of the upper jaw projecting a little over and forward of 
Ihe lower one, and the whole covered with a beautiful, smooth; 
firm yet elastic and slightly florid substance, called the gum ; 
the pressure of the finger does not give pain ; there is no un- 
natural heat ; the saliva is slightly viscid and not over abund- 
ant ; there is no swelling, discoloration, roughness, blotch or 
simple ; it locks as if its pristine purity had not been marred 
by either the extremes of heat or cold, by sweets or acids, by 
hot and stimulating ingredients and spices, by ruinous alcho- 
holic potions, by any drugs, or by any aliments, save what 
simple unsophisticated nature designed for it: in a word it 
has had nothing but the grateful nourishment afforded by its 
mother : this is the mouth of a child i^n a healthy state. 
Let us look upon it often, and with a discriminating eye, in 
order that we may become familiar with its appearance, and 
Ihereby be enabled to detect the approach of disease ; let us 
ii'ot look upon it with an " unconscious gaze, 1 * or with the 



Prom Infancy to old A$ei 189 

vacant stare of the maniac, who, the more he stares, the less 
he discerns : in order to avoid this, let us commence at some 
point, and examine the whole successively and minutely, and 
note any appearance, however small, or trivial, that does not 
correspond with the healthy appearances above described. In 
this manner, with a little attention and practice, we shall be 
able to detect the least appearance of disease; but, if we 
examine with a hurried, general, and indistinct glance at 
the parts, our information will be corresponding, and of little 
value. Those persons who examine thus may wait and wait, 
until their abused vision will painfully behold what a more 
discriminating one, with a little manual aid might easily have 
averted. 

This appearance it should maintain up to the sixth or eighth 
month of its age ; the common time for the commencement 
of the first dentition, at which time, the gums, instead of 
exhibiting the appearance above described, will become at 
'certain points swollen, discolored or more florid ; and to the 
touch less elastic and more tender, more heat, and betraying 
an itching sensation; the saliva will be more viscid and 
abundant, all of which will be the concornmitants of 
symptoms of a more general character, but which need not 
be enumerated here ; this is the commencement of the 
first dentition. The period is somewhat critical, and the 
symptoms will need to be closely watched, in order to see 
that the teeth pierce the gums without too much delay, and 
without occasioning too much nervous irritation ; which if 
Found to be the case, the process must be aided and accelerated 
by scarifying the gums ; that is, cutting them through with a 
sharp instrument directly at the swollen points and over the 
advancing tooth; and if the tooth lie deep, the incision should 
be made crucial or crosswise, and kept open by means of a 
little lint pressed into it, or the operation w r ill need to be re- 
peated until the tooth finds its way quite through the gum. 

These symptoms will recur in a greater or less degree, and 
this process need to be observed until the child gets ten teeth 



190 Management of the Teeth 

in each jaw, which make the number constituting the first 
dentition, and will carry the child to two or three years of age. 
For further information on this subject, see " Teething," 
page 31. 

When the first dentition is completed, the child has twenty 
beautiful pearls, well arranged, without spot or blemish* and 
very highly polished. It would seem that these perfect teeth 
need not be subject to corrosion and disease, yet so it is. Shall 
we like all culprits who wish to throw the blame from their own 
shoulders, attribute it to the innocent reproach of nature ? I 
tell ye nay, for in a majority of cases, the difficulty is the re- 
sult of neglect, causes not attributable to nature, and which if 
watched with that care which the importance of the teeth 
justly demands, would be perfectly under our control. The 
teeth would not so often be found defective, painful, rotten 
and broken off, for the diseases of the teeth, do not often spring 
up instantaneously, like the many heads of the formidable 
hydra ; but, on the contrary, it is feeble in its commence- 
ment, and slow in its progress and operation ; hence it may 
easily be combatted and overcome. Notwithstanding, a de- 
scription of the means necessary to be used to accomplish 
this object, will prove of very little advantage, for the tempo- 
rary teeth are generally considered of very little importance, 
and not worth any attention, as they are soon to be superced- 
ed by the permanent set : this is very true, but it is of great 
importance to the permanent teeth, that the mouth be kept 
healthy, as the following case will illustrate. 

Extracted this day, the two first permanent molarts of the 
lower jaw ; these teeth decayed on the side, in contact with 
the temporary molares which were decaying, the disease hav- 
ing been communicated to them by the latter teeth. 

A tooth decaying on its side is sure to produce disease in the 
one contiguous, from the chemical action of the acrimonious 
matter generated in it. 

To proceed then, for the benefit of those who may wish to 
be informed. The first change that will take place in these 



From Infancy to old Age. 191 

apparently so well constructed organs, will, in its commence- 
ment, be slight and scarcely persceplible; yet will neverthe* 
less, be destructive in its tendency. This change will often 
be a slightly brownish appearance on the front of the incisor 
teeth, near the gum, most frequently in the upper jaw, which 
gradually becomes more and more brown, until it may, in 
common language be denominated a brown scurf, hard to be 
removed. On examining such teeth minutely, this appear- 
ance will be found not confined to the surface ; for the enamel 
will be rough, and could it be examined with a microscope 
would be found full of thousands of little ragged cavities or 
depressions* which evidently have been occasioned by the 
disorganizing action of external agents, and these cells or cavi- 
ties are filled with foreign substances, which being long retain- 
ed, acquire acrimonious properties, and here the disease is 
perpetuated, and made to progress, until each cell enlarging, 
the whole surface and thickness of the enamel is destroyed, 
and the bony portion of the teeth being- thus exposed, presents 
but little resistance, and in its turn is soon, very soon, wasted 
by the disease, until at length, the teeth having become frail, 
are by some slight shock broken orT, and we see the child 
going about, making his expressions in lisping accents, which 
to the experienced ear at once betrays his loss. 

That this disease is the effect of chemical action, is evident 
from the fact, that it commences externally in the enamel, 
which is eroded : also, that in applying scaling instruments 
for its removal, we cut it off, and as we repeat stroke after 
stroke with the instrument, we observe that the main parts 
are removed, and that the cavities diminish in the size of their 
diameters and in their numbers, as we progress, until at 
length, we entirely obliterate them, unless the disease has 
penetrated the enamel. 

Where this disease occurs, the saliva will generally be found 
viscid or ropy, abundant and unhealthy ; hence it is obvious, 
that the corrosive action is occasioned by the state of the saliva, 



193 Management of the Teeth 

aided by filth, which is the consequence of neglect of the teeth, 
or in want of due attention to cleanliness. 

Cure. — Cut away the disorganized parts and polish the sur* 
faces of the teeth. 

Prevention. — Brush the teeth daily, and keep them clean. 
If the brush be not enough to effect this, a tooth powder must 
be used. When the disease commences, it may at once be 
stopped by cutting it away, and polishing with bits of soft 
wood and polishing powder. 

Remarks. — The above disease is not peculiar to the tempo- 
rary teeth : it is very apt to attack the permanent teeth of 
young persons, and there is nothing more destructive to them 
and productive of external decay ; for as soon as the enamel 
is destroyed, the bone of the teeth, exposed to the further ac- 
tion of the same agents, will decay. The scurf is generally 
seen thickest on the teeth near the gums, where the enamel is 
thinest and soon destroyed ; it also occurs to persons more ad- 
vanced in life. Let no person who values his teeth, his comfort,* 
his health, or regards his purse, be so foolish as to permit the 
disease in question, so perfectly under his control, to destroy 
his teeth, as though they were of no value, or the disease could 
not be prevented, any more than " the deadly blast from the 
desert air." 

Tooth Apparatus. — As some kind of apparatus will, at all 
times, be indispensably necessary for the good management 
of the teeth, we shall mention a simple one, which ought, (or 
something else in lieu of it,) to be in the possession of every 
individual. 

First — Tooth brushes of such forms as to be adapted to all the 
surfaces of the teeth, (see page 163,) and they will need to vary 
in size and shape in conformity to the size and circumstances 
of the mouth for which they are designed. 

Second — A piece of soft wood, of a convenient size and 
length to hold one end in the fingers, with the other applied 
to the teeth in any part of the mouth, this end being made 
thin and a little beveling, and broomed a little : this is to be 



From Infancy to Age. J&3 

used with polishing powder, in order to keep the teeth polish- 
ed in their interstices, where the brush has no effect : sticks of 
various thickness may be required, or altered at pleasure? 

Third — A fine steel instrument with a hooked point for re- 
moving any collection of tartar, foreign matter, or speck that 
may occur on the teeth. 

Fourth — An approved tooth powder. 

Fifth — A polishing powder to be used as occasion may re- 
quire with the bits of wood mentioned above. This powder 
should be pumice stone very finely pulverized ; it cannot well 
be made too fine : crocus two parts and pumice stone two 
parts, may be used if preferred : silk thread used with this 
powder is admirable for polishing between the front teeth. 

Some dentists recommend thread of waxed silk for passing 
between the front teeth to clean their interstices ; few will give 
themselves the trouble to use it ; tooth picks are most use- 
ful implements, and ought to be used after every meaL 

With this apparatus, and with a little care 5 every person 
can keep his teeth clean, and we may mention once for all 
(its importance cannot be too strongly urged,) keep the teeth 
perfectly clean and of the natural polish, use the brush morn- 
ing and evening, and a tooth powder in the morning if neces- 
sary, and use it freely enough to effect the object of its use. 
See " importance of cleanliness of the mouth," page 162 ; 
m brushing the teeth," page 164; " tooth powders," page 168. 

The decay of the temporary teeth, or the means that might 
be employed to arrest its progress, need not be mentioned. It 
is only necessary to keep watch that these teeth when diseased, 
do not injure the permanent ones. 

MANAGEMENT OF THE PERMANENT TEETH. 

Let the second dentition be so managed, that a regular and 
beautiful set of teeth be ensured. For the management of the 
teeth during the second dentition, see page 39. If there is a 
certainty that the teeth will be crowded, when the jaws are 
fully formed, from conformation of the teeth and parts, the two 
9 



194 Management of the Teeth 

posterior bicuspides in either jaw should be extracted ; but 
first, examine the four permanent molares, and if these teeth be 
defective, let them be removed in preference to the former. 
When the first permanent molares decay early so that they 
cannot be preserved, let them be early extracted : this is for 
the preventive treatment of decay, and is of the greatest im- 
portance. More than one half the diseases of the teeth may 
be prevented. See pages 97 to 104. 

In order that the permanent teeth may be preserved to the 
end of life, it will be necessary to bestow upon them that 
attention which their importance demands ; to use every 
means in our power for the prevention of disease, and the cure 
of it in its earliest stages. The diseases we have most 
to apprehend in youth are the brown scurf, just described, 
page 191, and decay. Whenever the following symptoms can 
be observed, look out, for decay has commenced and will 
certainly destroy the teeth, sooner or later, if it be not ar- 
rested. Therefore apply without delay to a thorough dentist. 
Let us examine critically and minutely the teeth through- 
out the mouth, (these observations are equally applicable to 
the teeth at any age,) and first the front and small double 
teeth on their sides : very often you will perceive a brownish 
or bluish appearance on the surfaces of these teeth opposite 
each other, and this appearance will be more or less percepti- 
ble, according to the quantity of foreign matter collected there, 
or the progress of the disease : apply the sticks of soft wood, 
described page 192, and the polishing powder, and remove 
the discoloration if possible; if this cannot be done, the enamel 
at the points affected will be found rough, discolored and per- 
haps completely destroyed. Let no time be lost in having 
these teeth separated and the filed sides nicely polished. (See 
u filing the teeth," page 128.) Again examine these teeth; 
the incisores on the inner surface at the protuberance near the 
gum ; the bicuspides between the two points on the grinding 
surface, and you will occasionally perceive a black spot ; let 
it be removed and the place polished : perhaps the teeth will 
require plugging, which is often the case : these teeth also 



From Infancy to old Age. 195 

decay on the external side, (though rarely if kept clean,) next 
the gum ; have it cut carefully away in its incipient stage. 
Let us proceed in our examination to the molar teeth ; look 
directly at the grinding surfaces of these teeth, in the lowest 
depression, usually in the centre of them, and you will often 
perceive a dark or bluish spot. To the inexperienced 
observer, this appearance will be attributed simply to the 
lodgement of foreign matter, and will be supposed not to pene- 
trate the enamel ; but apply your sticks and powder or a 
probe and lock of cotton and you cannot remove it : it is de- 
cay, and will often, ere this, have made considerable progress, 
even have penetrated more than half way to the nerve; indeed, 
the bony portion of the tooth will often have decayed so much, 
as to considerably undermine the enamel, even though there 
be apparently no external opening : therefore, have the teeth 
opened at once, the disease extirpated and the cavities plug- 
ged in the most substantial manner. As you value the teeth 
do not delay the operation; remember " a stitch in time saves 
nine." The operation will not cost half the pain that it will 
if neglected, and it is always sure of success : if it be delayed 
till the nerve is exposed, it may be difficult to preserve the 
tooth, and at best the operation must be vastly more painful, and 
not so sure of success; besides, what can be gained by delay? 
It is a great fault with the generality of persons, that they do 
not have dental operations performed so early as they ought, 
in order to obtain the greatest possible benefit and the most 
satisfactory results. 

Again, let us continue our examination ; a black spot will 
be observed on the molar teeth, on the side midway between 
the gum and grinding surface : let it be attended to ; these 
teeth also decay on the side near the gum, and on the con- 
tiguous sides; let the advice of a judicious dentist be at once 
pursued. 

It is necessary to make but few further observations with 
respect to the management of the teeth. The diseases by 
which the teeth are generally lost have been fully described ; 
also, the preventive and curative treatment of them. 



196 Management of the Teeth 

One thing more we have to recommend to those who are 
anxious to preserve the teeth — it is this. Every person should 
choose a dentist, in whose skill, integrity and fidelity, he can 
place the firmest reliance, and have his mouth regularly 
examined once or twice a year; once a year is, generally, 
enough, but when there is a powerful predisposition in the 
teeth to decay, the mouth should be examined twice a year 
or oftener. There are great advantages in this procedure to 
the lovers of sound teeth, for an individual seldom discovers a 
tooth to be decaying, till the disease has made considerable pro- 
gress, and very often not till it has progressed to the very nerves 
and the pangs of tooth ache give him sad warning. Another 
advantage, it costs the individual nothing more than a little 
trouble, and the satisfaction of knowing that his teeth are all 
well, amply repays him. 

The peculiar color of decaying teeth, always informs the 
experienced eye. We have often pointed out to our patients 
teeth that were decaying, especially the small double teeth, 
when they, nor their friends could not perceive any symp- 
toms of disease, and have gone to work boldly with the file 
to separate such teeth in order to enable us to get at the disease 
for the purpose of plugging, till our distrusting patient and his 
friends, saw plainly the truth of our assertions. We have 
often exposed the very nerves of teeth, before we could com- 
pletely extirpate the disease, in teeth that our patients never 
dreamed to be decaying. These facts show the importance 
of our advice ; indeed, the positive necessity of its being fol- 
lowed. 

" The most useful advice with which I can conclude these 
remarks, is to urge on every individual the necessity of aim- 
ing at the prevention of disease altogether, which can in a 
great measure be effected without engrossing more time thaa 
its importance merits. 

44 This is a subject which demands the attention of parents, 
and those we are entrusted with the care of children. It 
should be the first object of every person so situated, to habit- 



From Infancy to old Age. 19? 

tiate children to clean their teeth, at least twice a day, and 
when this practice has been once adopted, it will be continued 
as a matter of course. Besides this, from the age of six to 
twelve years in particular, a dentist should be consulted three 
or four times a year, and at a later period, once or twice for 
the purpose of examining the teeth, and counteracting, by the 
timely removal of such causes as may produce disease, any 
mischief which is likely to take place." — Parmly's Notes to 
Brown's Dentologia, 171. 

Many persons think that if they have the teeth once oper- 
ated on, it is quite enough, and that it will secure them from 
future decay ; this is a great error and has caused the loss of 
many teeth. We have had many opportunities of examining 
the mouths of individuals, whose teeth were thoroughly " put 
to rights" ten years before ; in many cases, those teeth that 
were plugged long before, stood firm amid the ruin of others, 
sound at the time they were operated on. 

The polite semenaries in London and Paris, also in most of 
the large towns in Great Britain and France, generally have 
a dentist attached to them, who regularly examines the mouths 
of the pupils two, three or four times a year, and thus is en- 
abled early to correct any disposition of the teeth to irregularity. 
We do not so often meet with deformed teeth, among well 
bred foreigners, as in our own country. It were to be wished 
that the same plan be adopted in our boarding schools. 

" In our modern polite semenaries, the children's teeth are 
frequently examined and kept in order by a dentist. This is 
a regulation that prevents much future pain and regret, and 
one for which they, when grown up, will be far more grateful, 
than for the lighter accomplishments. " — Murphy, page 74. 



198 Concluding Observations, 



CONCLUDING OBSERVATIONS. 

We believe that any person of candor, after having perused 
the facts presented in this work, will admit that " the loss of 
the teeth is not a necessary consequence of age," or a neces- 
sary result of disease, but that the diseases of the teeth are 
curable, (how inconsistent to suppose that any disease not 
malignant, non-curable;) that they may, in a great measure 
be prevented, and hence, that " the teeth of most persons, 
may be preserved to the end of life." 

That the teeth are very liable to disease in America, is pro- 
verbial, both at home and abroad ; and it is lamentably true, 
that many lose more or less of them before the age of twenty 
years, and that few comparatively pass the age of forty, with 
perfectly sound teeth. Without the possession of oracles or a 
prophetic eye, we fear that we may safely claim the prescience 
to foretel, that the teeth of our countrymen will continue bad 
to the end of time — that their teeth will be toasted forever— 
that good teeth will be envied and wished for — that thousands 
of pretty faces will be spoiled for the want of good teeth, and 
that diseased teeth will continue to be the cause of an infinity 
of suffering. And why ? because people will not be convinced 
of the. importance and necessity of early and constant at- 
tention to the teeth, for the preventive and curative treatment 
of the diseases to which they are subject; or, if they will be, 
there are so many circumstances to prevent the above treat- 
ment from being put into execution. 

And first, the solicitude of the parent, for the safety of the 
child, will often prevent the performance of those little and 
trifling operations sometimes necessary, to ensure the regular- 
ity and symmetry of the coming permanent teeth, or for the 
preventive treatment of decay. What a pity ! yet so it is. 
We have too often witnessed this result ; if a child makes 
a great ado, it is no reason why that which is necessary 



Concluding Observations, 199 

to be done for his welfare, should be neglected. If flattery, 
presents, and lastly threats do not induce submission, compul- 
sion is the only alternative: he should have one sympathy, 
and that sympathy should induce us to enforce what is so ne- 
cessary to his future welfare, and he will be grateful for it, 
when he shall have grown to years of discretion. 

Second — The trouble of keeping the teeth clean and free of 
foreign matter. Fie ! how much trouble to wash our hands, 
clip our beards, and put up our curls. Not wash the mouth ! 
What pa:t of the frame would delicacy of feeling prompt us 
to keep more cleanly 1 What is there more disgusting than a 
foul mouth, or an offensive breath ? 

Third — The dread of the pain of dental operation for the 
cure of the diseases of the teeth. There are many persons, 
especially ladies, who will neglect to have the above operations 
performed, till the agonies of tooth ache compel them to seek 
relief, when perhaps disease has made such sad ravages, that 
little can be done ; they have got the idea, that operations on 
the teeth are dreadfully painful ; — they shrink with horror 
at the thought — the tales of those who have experienced them, 
(for they exaggerate in a tenfold degree,) tend rather to confirm, 
than remove their apprehensions. Opinions on this head are 
so erroneous, so prevalent, and so productive of misfortune, that 
we must beg the indulgence of the reader for a moment. We 
have often found the greatest difficulty, notwithstanding the 
most candid assurances, in removing the alarm and dread of 
individuals, where there was no occasion for the least appre- 
hension. Here is the truth, as to the real pain of dental 
operations for the cure of decay : if they be early performed 
they cost the patient little or no pain — put them off till com- 
pelled to have recourse to them, and they are often very pain- 
ful ; some suffer much more than others on account of the 
difference in the sensibility of the teeth. Finally, many per- 
sons suffer far more from the dread of dental operations, than 
from the actual pain of them. Why put off the operations 
necessary for the cure of decay ? Is pain the reason ? You 



£00 Concluding Observations v 

i 

will pay too dearly. Do you value personal appearance? 
dfelay often produces sad deformity. Let him who values his 
teeth, never neglect either the preventive or curative treatment 
of their diseases.' 

Fourth — Quackery and Empiricism. A man, to be enabled 
perfectly to manage the teeth, and to cure their diseases, must 
possess some knowledge of medicine and surgery, (see note page 
107 )) great mechanical skill, honesty and integrity, that he 
may perform all his operations in the most thorough and per- 
fect manner? 



ARTIFICIAL TEETH/ 



I'he loss of the teeth is remedied by the substitution of arti- 
ficial ones. For this purpose* dentists employ the natural 



* " When a partial deficiency of the teeth is supplied with judgment 
and skill, it is the means of preserving the remaining natural teeth, by 
becoming a support to therm 

" Entire sets of teeth are worn with great ease and satisfaction, when 
well made and rightly adapted. The construction and adaption of arti- 
ficial teeth is an art in which some professors greatly excel others j there 
must of consequence, be a variety in trie value of their works. Some 
teeth are so ill made and unskilfully adapted, that they are troublesome 
to the wearer, an impediment to the speech and mastication, and even a 
greater blemish to the countenance, than want of teeth ; those that are 
Veil adapted are, on the country, easy, useful and ornamental." — Joseph 
Murphy. 

" The greatest improvement on the art of the dentist was a right un- 
derstanding of the uses of the back teeth ; and it is still a matter of 
astonishment how very few of its professors have emerged from the 
ignorance of the first dentists ; the practice of the latter consisting in 
fastening the tooth or teeth to be inserted to the adjacent teeth, by means 
of ligatures. An improvement On this method was to form the artificial 
teeth of the hardest bone, so as to resemble nature, sockets of the same 
materials being left so as to resemble the gums. As the bone, from the 
moisture of the mouth, soon becomes discolored, natural teeth began to 
be inserted on sockets of bone so nicely adapted to the parts for which 
they were intended, as to answer the purposes of mastication, &c. with- 
out inconvenience ; and this method, variously modified, continues still 
to be the favorite practice with almost every dentist. The state of the 
back teeth is a matter of the first consideration to the success of the oper- 
ation of pivotting teeth on old stumps. If the back teeth are wanting, 



201 Artificial Tteth. 

teeth ; the tusk of the hyppopotamus or river-horse; the teeth 
of animals, usually of the cow, and mineral substances, va- 



the jaws approaching nearer than usual in mastication, a degree of fric- 
tion on the front teeth ensues, which soon wastes or loosens them. \n 
supplying artificial teeth of every kind, this circumstance ought always 
to be kept in view ; otherwise the operation Can never prove honorable 
to the dentist, nor satisfactory to the patient. 

The fixing of artificial teeth on gold plates properly adapted to the 
gums, is, from its universal applicability, perhaps the best mode now in 
use. It is, however, when properly executed, the most difficult and least 
understood. Such are the lute improvements by means of gold plates, 
that where every other method would fail, even in the ablest hands, they 
con succeed with certainty in this. It has, in fact, given a new tone to 
the art, and raised it above the imperfections so generally ascribed to it. 

" A common method of making these plates of gold was to form them 
into something like the shape of the parts to be supplied with teeth, 
by merely bending them with a pair of pliers, and forcing them into 
their intended place, which naturally forced out the teeth with which 
the plate came in contact ; or if claws or springs were added, the same 
injurious result was produced. Those who improve on this method, 
have models of the mouth cast in brass, on which the plate was moulded 
in the way that dies are usually worked upon. So sensible of the diffi- 
culty of properly executing this model are many of the first dentists, that 
they never undertake it at all. The last improvement in gold plates was 
to cover over with caps, formed out of one plate, such back teeth or 
stumps as remained when partially worn down by attrition or decay, go 
as to prevent the contact of the front teeth in mastication. 

"A dentist who worked in bone only, would, when a case requiring a 
gold plate formed into caps for them occurred, be under the necessity of 
extracting such irregular teeth or stumps as interfered with his opera- 
tions, or to make a covering of bone so fine as to break in mastication ; 
whereas the use of such gold plate renders extraction unnecessary in 
every case where the teeth or fangs are not otherwise troublesome. But 
in many cases, the union of gold and bone are necessary to produce the 
desired effect ."— Andrew Clark. 

The substitution of teeth on gold plates, is an extremely nice art, in 
which some dentists greatly excel others. It is of the utmost importance to 
the possessor of them, that the plates be made to fit perfectly, and do not 
exert too much pressure on the adjoining teeth or their ruin will be cer- 
tain, and that too, in a short time. A vast deal of mischief is produced 
by the unscientific manner, in which many dentists attach artificial 
teeth to the natural ones. (See note page 109.) 

Grafting or pivotting teeth on stumps. — < l When either or all of the 
six front teeth are decayed and painful, or unsightly so as to render their 
presence disagreeable, natural teeth may be fixed to the roots. Whenever 
this method ef affixing teeth can be adopted, it is far preferable to any 
other ; for as long as the roots remain firm, which is often for many 
years, we can renew them at any time, without the least inconvenience, 
as they are independent of any other teeth ; they may be fitted so nicely, 
ajg to defy detection, even on minute inspection. If the root is sound, 



Artificial Teeth. 203 

Viously called according to their composition, or the fancy of 
the manufacturer, mineral teeth, silecious metallic teeth, por- 
celain teeth, and incorruptible teeth. Of all animal substances, 
the natural teeth are much to be preferred. 

Mineral teeth are now manufactured by a very few individ- 
uals in this country* in such perfection, that they so closely re- 
semble nature in every particular, as to make it impossible for a 
common observer to distinguish them from the natural teeth 
when properly inserted. There is nothing in nature so difficult 
to imitate, especially from the mineral kingdom, as the teeth, 
on account of their peculiarities ; and first, their semi-transpar- 
ency ; second, a their peculiar color which is much the strongest 



they will, by their firmness, answer every purpose, almost equally well 
as the former natural teeth, whose place they occupy." — Fuller. 

When a front or small double tooth becomes so much decayed that it 
Cannot be preserved by plugging, the carious crown should be cut off at 
once, and an artificial tooth substituted. There are great advantages in 
this proceedure, for it is of the utmost value that the stump be sound and 
healthy in the socket. The vitality of the fang of a tooth does not alto- 
gether depend upon the nerve, but rather upon the vascular and vital 
connexion existing between the socket and fang ; hence, if an artificial 
tooth (a mineral tooth) be properly substituted on a healthy stump, it 
will often last a great number of years, even twenty or thirty years, and 
be almost as useful and comfortable as the natural tooth : but if the oper- 
ation be delayed till the stump be very much decayed, or diseased in its 
socket, the artificial tooth will not last long and cause much trouble, be- 
cause the fang has become a dead and foreign body, and gum -biles are 
frequently the consequence : the fang is at length removed and a tooth 
substituted on a plate, which if not properly fitted, may play the mischief 
with the adjoining teeth. We wish to urge the importance of the above 
advice, for very many persons put off the operation too long ; if it must 
be done, why may it not as well be done first as last ? We often hear 
thoughtless persons, (young ladies especially, of a timid disposition, who, 
when their teeth begin to decay, will not allow the necessary operations 
for the cure of the disease, to be performed,) declare that they would 
not have an artificial tooth, should they lose one by decay. 

The loss of a front tooth is felt so much, or the chagrin it occasions is so 
great, that any person will get its place supplied, even the most menial. 
The most timid young lady who could not be persuaded to submit to the 
trouble of having her teeth preserved, will readily suffer the necessary 
pain of having those she has lost, replaced. 

Finally, the pain which the substitution of a tooth on the stump occa- 
sions, if the nerve fee dead, is trivial, and not worth minding. The 
filing of the stump produces nothing more than an unpleasant sensation ; 
even when the nerve is alive, it can be destroyed with very little paip, 



204 Artificial Teeth. 

next to the gum, and their great variety of tints ; and third, 
their great variety of shape, position, and from collateral cir- 
cumstances. To overcome all these difficulties, has long 
been considered a desideratum, and at length, after an infinity 
of experimental research, has been accomplished by the inde- 
fatigable exertions of a few scientific inen. 

Mineral teeth possess such great advantages over all other 
kinds of teeth, that it is to be hoped, that their general use 
will soon banish all others from dentistry : they are greatly 
to be preferred for these reasons. 

First— Natural or animal teeth will decompose more or less 
rapidly in the mouth : in some mouths, they will not last more 
than two or three years ; in others, they will last six or seven ; 
as a general rule, they will not last more than five years, and 
then must be renewed. Mineral teeth are indestructible, and 
therefore in the end are a great saving in expense. 

A stump to which an artificial tooth is attached, will last 
much longer if a mineral tooth, instead of a natural one, be 
employed, because the natural tooth beginning to decompose, 
occasions the stump to decay. A mineral tooth does not pro- 
duce this effect. 

Second — The natural or animal teeth soon begin to decom- 
pose, and become exceedingly fetid and disgusting. The 
mineral teeth are always sweet and clean. 

The great objection made to mineral teeth, heretofore, has 
been, that they did not sufficiently imitate nature. The 
French porcelain teeth which are brought to this country in 
great quantities ; also, those manufactured here by most per- 
sons, do not possess the characteristic appearances of the natu* 
ral teeth, and therefore are detected at a glance. 

Mineral teeth are made in America, in much greater per- 
fection, than in any other part of the world, if we can judge 
from the numerous specimens that have fallen under our ob- 
servation. 

To mention the names of those individuals, who, in our 
opinion, manufacture mineral teeth in the greatest perfee- 



Artificial Teeth. 205 

tion, might appear invidious, and is wholly unnecessary, as 
those interested ivill judge for themselves ; yet, we hope we 
may be allowed the indulgence of saying, without tresspassing 
on the limits of modesty, or infringing upon the privileges or 
merits of any individual, that, in our candid judgement, the 
teeth which possess all the requisite qualities before mentioned, 
in the greatest perfection, are Spooner's mineral teeth, invented 
by Dr. J. It. Spooner, of Montreal, by a long series of indefat 
igabie, laborious and expensive experiments. 

Many specimens of these teeth have been exhibited in New 
York, and many of them inserted by different dentists in the 
state ; yet the process of manufacturing has been so tedious 
and expensive, that they have not been offered in the market 
for general use. They are manufactured by myself and part- 
ner in New York, where they can be examined by those who 
wish to satisfy themselves with respect to their merits. 

We believe our teeth superior to all others, (and it is admit- 
ted by the disinterested members of the profession,) for these 
reasons. 

First — We get a greater variety of tints than any other 
manufacturer, which enables us to imitate nature much more 
closely. 

Second — We can mount our teeth on gold plates singly as 
other dentist do, with solder, the rivet, or the screw. W"e can 
also make them in blocks with an artificial gum, or in one 
entire piece, which circumstance, give us great advantage over 
others manufacturers of mineral teeth. 



GLOSSARY 



OF TECHNICAL TERMS, 



A. 

Anatomy — The dissection of dead bodies so as to expose the structure 
and uses of the parts. 

Abscess — A cavity containing purulent matter. 

Absorption, from absorbeo, to suck up — A function in an animated 
body, by which substances applied to the mouths of absorbing vessels 
are taken up. Thus the nutricious part of the food is absorbed from 
the alimentary canal. 

c. 

Calculus — Diminution of calx, limestone. Stone or calcarioua con- 
cretions found in various parts of the body. 

Caries — Rottenness, mortification of the bones. 

Cartilage — A white, elastic, glistening substance covering the ends 
of bones, commonly called gristle. 

Crystalline lens — A pelucid body of the form of a lens situated in the 
anterior part of the vitreous humor of the eye. Its use is to transmit 
and reflect the rays of lierht. 

D. 

Dentes— Teeth : the front teeth are termed incisores from incidere> to 
cut; the eye teeth cuspidate from cuspis, a spear, spear-pointed; the 
email double teeth bicuspides from bis twice and cuspis ; and the large 
double teeth molares from molaris, a millstone, grinders. 

Dantes sapientice — Wisdom teeth, last molares. 



Glossary ef Technicalities. 207 

F. 

Functions — The functions of the body are divided by physiologists 
into vital, animal and natural. The vital functions or actions are these 
iildispensible to life, as the action of the heart and lungs. Animal func- 
tions are those performed at will, as muscular action and all voluntary 
motions of the body. The natural functions, are those which may be 
interrupted for a longer or shorter time without destroying life, as the 
functions of digestion, of the liver, kidneys, &c. 

G. 

Gangren — Mortification. 



Inflammation from inflammo, to burn — A disease characterized by 
pain, heat, redness and swelling ; it terminates in resolution, adhesion, 
suppuration and mortification. 

Inflammation, adhesive — Inflammation in certain tissues of the body, 
terminates in the pouring out of lymph, which becomes organized and 
cements the adjoining parts together, asd is termed adhesive inflamma- 
tion. 

Internal membrane — The pulp or nerve of a tooth, as it is commonly 
called. 

M. 

Mortification —To make dead : termination of inflammation, the 
violence of which causes the death of the parts involved in the disease, 



Pathology — A discourse on disease ; the doctrine of diseases. 
Periosteum — Round a bone ; the membrane that invests the bones. 
Pericranium — The membrane that surrounds :he skull. 
Physiology — A discourse on nature; that science which has for its 
object, a knowledge of the phenomena proper to living bodies. 
Pus — The matter discharged from a sore. 
Purulent— Consisting of pus. 
Puriform— Having the appearance of pus. 

R. 

Resolution — A termination of inflammation, in which the disease dis- 
appears without forming an abscess or causing mortification. 

S. 

Suppuration — That action by which pus is formed during inflamma- 
tion. 

V. 

Vascularity^ from vas, a vessel. Vascular having vessels. 



ERRATA. 

Page 96 line 22, for " preventative and curative treatmen,'* 
read preventive and curative treatment. 

Page 97 line 10, for " who enjoy such health that the secre- 
tory organs be not destroyed," read secretory organs be not 
deranged. 



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